Keep current with new legislation and its potential effect on your organization. This regulatory update is for informational purposes only, and provides some key highlights on state initiatives that may impact the bill review services Genex provides.
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National
The Centers for Medicare and Medicaid (CMS) has posted the quarterly payment rate updates for the following fee schedules, effective April 1:
- Ambulatory Surgery Center
- Durable Medical Equipment, Prosthetics/Orthotics & Supplies Fee Schedule (DMEPOS)
- HCPCS ‘C’ Codes
- Physician Fee Schedule
California
The Division of Workers’ Compensation (DWC) has ordered adjustments to the Physician/Non-Physician practitioner services, DMEPOS, and the Hospital Outpatient and Ambulatory Surgical Centers section http://www.dir.ca.gov/DIRNews/2018/2018-25.pdf of the Official Medical Fee Schedule to comply to Medicare changes and is effective April 1.
Fraud Watch: The DWC also announced this month that it has suspended eight providers for fraud or loss of license. The recent actions bring the total number of suspended providers to 242 since the implementation of the anti-fraud bill, AB 1244, which went into effect Jan. 1, 2017.
Connecticut
The state Workers’ Compensation Commission has updated its Hospital and Ambulatory Surgical Center Fee Schedules. The updates became effective April 1.
Georgia
The state Board of Workers’ Compensation has updated its Medical Fee Schedule which took effect April 1.
Kentucky
The Department of Workers’ Claims (DWC) has announced that Advanced Practice Registered Nurses (APRN) who practice independently and not under the direct supervision of a physician may bill directly for medical services provided to workers’ compensation claimants pursuant to KRS 342.020.
In other DWC news, the department has announced changes to its cost-to-charge ratios for hospitals, ambulatory surgery centers, and out-of-state hospitals. The changes went into effect April 1.
New York
The state Department of Health has updated its DME Services Fee Schedule. The changes went into effect April 1.
The Workers’ Compensation Board has issued its revised medical authorization forms. It has also added an update concerning health provider’s authorization to treat workers’ compensation claimants and/or conduct independent medical examinations.
North Dakota
Files for the Provider Medical and Physician Drug fee schedules have been updated by the state’s Workforce Safety and Insurance department. The new schedules became effective April 1.
Oregon
The Workers’ Compensation Division has issued Bulletin 290 which includes the updated cost-to-charge ratios for hospitals and took effect April 1. This new initiative replaces a similar bulletin that was issued in March 2017.
Pennsylvania
The Bureau of Workers’ Compensation has issued its Medical Fee Schedule Second Quarter update.
