News and Updates

  • New OMFS Fee Schedule March 1, 2017

    DWC Posts Adjustments to Official Medical Fee Schedule (Physician Services / Non-Physician Practitioner Services)

    The Division of Workers’ Compensation (DWC) has posted an order adjusting the Official Medical Fee Schedule (OMFS) to conform to changes in the Medicare payment system as required by Labor Code section 5307.1.

    The Physician and Non-Physician Practitioner Fee Schedule update Order adopts the following Medicare changes:

    • Centers for Medicare and Medicaid Services (CMS) Medicare National Physician Fee Schedule Relative Value File RVU17B April 1, 2017 quarterly update • National Correct Coding Initiative Physician/Practitioner Services CCI Edits  April 1, 2017 quarterly update • National Correct Coding Initiative Medically Unlikely Edits April 1, 2017 quarterly update

    The order adopting the OMFS adjustments is effective for services rendered on or after April 1, 2017 and can be found on the DWC website.

  • Senate Bill 1160 - Supplemental Lien Declaration Form and Section 4903.05(c) Declaration
    As of January 1, 2017, Senate Bill 1160 adds requirements to verify that a lien is legitimate, that it is filed only by the lien holder, and that that liens owned by providers who have been indicted or charged with crimes be stayed until the disposition of criminal proceedings. In compliance with these new requirements, the Division of Workers’ Compensation will make available an amended lien form which includes the required declaration under newly enacted Labor Code Section 4903.05(c). All liens filed after January 1, 2017 must use this new form. Liens that are subject to the filing fee and filed without the declaration will be dismissed. SB 1160 also requires that all lien claimants file an original bill with their lien. SB 1160 additionally reduces utilization review requirements in the first 30 days following a work-related injury. It also mandates electronic reporting of utilization review data by claims administrators to the Division of Workers’ Compensation, which will enable the division to monitor claim processes and address problems.
  • Senate Bill 1175 and Timely Filing
    Amends Labor Code 4603 Effective January 1, 2017 The first section of SB 1175 is concerned with timely bill submission for medical treatment. It amends Labor Code 4603 to require that providers submit bills for services within 12 months of rendering services or the date of discharge from an inpatient facility. This timely bill submission requirement applies to providers of services, including (but not limited to): Physicians Hospitals Pharmacies Copy Services Transportation Services Home health care services The requirement does not apply to dates of service prior to January 1, 2017. Crucially, the amended Labor Code specifies that no payment is due for untimely bill submission. Amends Labor Code 4625 Effective January 1, 2017 Section 3 revises Labor Code 4625 to state that medical-legal evaluation and related service bills, like other bills, must be submitted within 12 months from the date of service. This requirement does not apply to bills with dates of service prior to January 1, 2017. The amended Labor Code does not allow exceptions for this timely billing requirement. Med-legal bills are barred unless timely submitted.
  • Medicare will pay for non-face-to-face prolonged services starting January 1, 2017
    CCM and Complex CCM reimburse providers for clinical staff time spent providing care management services, not time spent by physicians.  Recognizing the additional resource costs involved in spending an extraordinary amount of time outside the office visit caring for an individual patient’s needs, CMS proposes to make payment under two codes: CPT 99358 – Prolonged E/M service before and/or after direct patient care, first hour CPT 99359 – Prolonged E/M service before and/or after direct patient care, each additional 30 minutes, with a limit of two units (listed separately in addition to CPT 99358) In discussing these services, CMS warns the time counted for these codes must be beyond the usual service time for the primary or companion E/M code that is also billed; no time can be counted more than once toward the provision of CPT 99358, 99359, and any other service reimbursable under the Medicare Physician Fee Schedule.