The State of the States

Regulatory Review

Key workers' comp regulatory developments from around the country.
By: | April 7, 2014


Medical fee schedule. The Division of Workers’ Compensation posted an order adjusting the physician services and nonphysician practitioner services section of the official medical fee schedule to conform to changes made to the Medi-Cal Rates database. Medi-Cal updates its rates file on the 15th of every month and posts it on the 16th. The division will issue an administrative director’s order every month to adopt the updated Medi-Cal rates file for services effective on or after the 15th of the month.

Inpatient hospital services. The Division of Workers’ Compensation amended the inpatient hospital fee schedule in the official medical fee schedule to conform to changes in the Medicare payment system. The amendments reflect Medicare’s changes to the relative weights and geometric mean length of stay for the listed Medicare severity diagnosis-related groups. The effective date of the new diagnosis related group relative weights are for inpatient hospital discharges occurring on or after March 15.


Shoulder injuries. The Workers’ Compensation Commission issued a memorandum announcing an update to the protocols for treatment of shoulder injuries. The revisions reflect the latest changes in the medical field regarding new procedures, treatments, and diagnostic tests. The commission explained that the protocols are not meant to be absolute; there must be room for medical judgment. Medical providers are urged to contact the insurer if they feel that a treatment pattern other than the published protocol is required. The protocols will be used by the commission to evaluate whether a treatment is reasonable and appropriate based on the diagnosis of injury or illness. The revised protocols go into effect on April 1. The commission noted that it is working with practitioners, insurers, and the medical advisory panel on updates to the medical protocols for treatment of injuries to the knee, hand, and foot/ankle.


Assessments. The Division of Workers’ Compensation proposed amendments to rules regarding the payment of assessments for the Workers’ Compensation Administration Trust and Disability Trust Fund. The rules adopt a form that must be used by all carriers and self-insurance funds to report quarterly assessments owed to the Workers’ Compensation Administration Trust and Disability Trust Fund. The division will provide the form to carriers and self-insurance funds no later than five days before the end of each quarter. All carriers and self-insurance funds required to pay assessments must return the completed form and pay all assessments no later than 30 days from the end of the quarter. The rules also provide for an offset for dividends and premium refunds.

Ambulatory surgical center reimbursement manual. The Division of Workers’ Compensation scheduled a public meeting to receive comments related to possible changes to the ambulatory surgical center reimbursement manual. The division is considering changes regarding maximum reimbursement allowances established for specific procedure codes, electronic billing policies for payors and payees, and the Florida workers’ compensation uniform medical treatment/status reporting form. The public meeting is scheduled for April 1 from 9:30 a.m. to 4:30 p.m. in room 102, Hartman Building, 2012 Capital Circle SE, Tallahassee. Those with questions should contact [email protected]

North Carolina

Electronic medical billing and payment. The Industrial Commission finalized the electronic billing and payment companion guide. The date for implementation of electronic medical billing in the electronic billing rules is March 1. However, the commission will not require compliance with the electronic billing rules until July 1, with regarded to electronic medical billing processes. The rules and portions of the companion guide that govern and require electronic medical payment processes will not be mandatory until Jan. 1, 2015. The commission also announced that it will delay the mandatory implementation date for medical bill reporting via electronic data interchange until July 1. The commission stated that no additional extensions will be granted.


Electronic data interchange. The Workers’ Compensation Division revised its rules governing electronic data interchange of medical bill data. Data elements for the employer’s address, city, state, postal code, and country code were added. Under the claimant information category, a data element for replacement claim administrator claim number was added. The changes go into effect on July 1. After the closing date for testimony on the rules, the division became aware of additional technical problems. The division intends to further amend the rules to address the problems. Those with questions should contact [email protected]


Medical aid rules. The Department of Labor and Industries proposed amendments to the medical aid rules. The rules increase the conversion factor used to calculate payment levels for services payable through the resource-based relative value scale fee schedule from $55.34 to $58.58.

The rules increase the conversion factor used to calculate payment for anesthesia services from $3.25 to $3.31. The rules also increase the maximum daily payment for physical and occupational therapy services from $119.96 to $122. The department scheduled a public hearing on March 25 at 1 p.m. at 7273 Linderson Way SW in Tumwater. Written comments should be submitted to [email protected] by 5 p.m. on April 1.

Christina Lumbreras is a Legal Editor for Workers' Compensation Report, a publication of our parent company, LRP Publications. She can be reached at [email protected]

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