PENALTY AND INTEREST
California Workers’ Compensation law mandates penalties and interest when payers fail to timely pay a properly submitted bill. Below are the mandatory timeframes for paying medical bills. Penalties and interest start upon receipt of the bill by the payer:
|Bill Submission||Payment Deadline
|E-Bill (Treatment & Med-Legal)||15 working days||15 working days|
|Paper Bill (Treatment)||45 calendar days||60 calendar days||15% penalty+ 10% interest per annum|
|Paper Bill (Med-Legal)||60 calendar days||60 calendar days||10% penalty + 7% interest per annum|
Note: Payment for electronic bills is due in 15 days; however, penalties and interest apply after the 45 or 60 days respectively (same as paper bills).
California LC Section 4603.2(b) (2) mandates: “A properly documented list of services provided and not paid at the rates then in effect under Section 5307.1 within the 45-day period shall be paid at the rates then in effect and increased by 15 percent, together with interest at the same rate as judgments in civil actions retroactive to the date of receipt of the itemization, unless the employer does both of the following:
(A) Pays the provider at the rates in effect within the 45-day period.
(B) Advises, in an explanation of review pursuant to Section 4603.3, the physician, or another provider of the items being contested, the reasons for contesting these items, and the remedies available to the physician or the other provider if the physician or provider disagrees. In the case of an itemization that includes services provided by a hospital, outpatient surgery center, or independent diagnostic facility, advice that a request has been made for an audit of the itemization shall satisfy the requirements of this paragraph.”
Section 6.4(a) of the DWC Medical Billing and Payment Guide,
Any non-electronically submitted bill determined to be complete, not paid within 45 days (60 days for a governmental entity) or objected to within 30 days, shall be subject to audit penalties per Title 8, California Code of Regulations section 10111.2(b)(10),(11).
- Any non-electronically submitted complete bill for uncontested medical treatment provided or prescribed by the treating physician selected by the employee or designated by the employer not paid by the claims administrator within 45 days of receipt, or within 60 days if the employer is a governmental entity, shall be increased 15%, and shall carry interest at the same rate as judgments in civil actions retroactive to the date of receipt of the bill unless the health care provider, health care facility or billing agent/assignee is notified within 30 days of receipt that the bill is contested, denied or considered incomplete. The increase and interest are self-executing and shall apply to the portion of the bill that is neither timely paid nor objected to.
Except as provided in subdivision (b), within 60 days after receipt by the employer of each separate, written billing and report, and if payment is not made within this period, that portion of the billed sum then unreasonably unpaid shall be increased by 10 percent, together with interest thereon at the rate of 7 percent per annum retroactive to the date of receipt of the bill and report by the employer. If the employer, within the 60-day period, contests the reasonableness and necessity for incurring the fees, services, and expenses using the explanation of review required by Section 4603.3, payment shall be made within 20 days of the service of an order of the appeals board or the administrative director pursuant to Section 4603.6 directing payment.