case law

Case law is defined as "the reported decisions of selected appellate and other courts (called courts of first impression) which make new interpretations of the law and, therefore, can be cited as precedents in a process known as stare decisis." The ACOEM (American College of Occupational and Environmental Medicine) Guidelines were created to halt the practice of excessive and unnecessary treatment and to reduce the costs of medical treatment in an average Workers' Compensation claim.

Whether we like it or not, Legislation in California has mandated the use of the ACOEM guidelines for the treatment of all Workers' Compensation patients. All treatment requests will now be submitted to Utilization Review for compliance with the necessity of the treatment being requested. This has caused uproar in many medical practices and does have an effect on the billing procedures at your practice.

The following Workers' Compensation cases affect daily billing practices:

• Boehm & Associates v. WCAB (Lopez) (1999) 64 CCC 1350
• In Re Crawford and Company (September 22, 2000 Order), Crawford #2
• Tenet/Centinela Hospital Medical Center v. WCAB (Rushing) (2000) 65 CCC 477
• Valdez case; CNA Insurance Company v. WCAB (1997) 62 CCC 1145
• Wells case; Southern California Edison Co., et al. v. WCAB (1999) 65 CCC 100

We stay up-to-date on all of the latest cases so we can keep you informed! Call our office for details on these cases and how they affect your practice.