Workers' compensation; fee schedule for medical care services, prompt payment of bills. (HB946)

Introduced By

Del. Tim Hugo (R-Centreville)

Description

Workers' compensation; fee schedule for medical care services; limitations; prompt payment. Limits the pecuniary liability of an employer for medical, surgical, and hospital services provided on or after October 1, 2015, pursuant to the Virginia Workers' Compensation Act to the maximum amount that may be paid pursuant to fee schedules established by the Workers' Compensation Commission, unless a contract provides otherwise. The Commission is directed to promulgate regulations establishing medical care fee schedules governing all medical care services rendered pursuant to the Act. The regulations implementing the schedules shall become effective on October 1, 2015. The bill requires the medical care fee schedule regulations to (i) initially be based on Medicare, (ii) utilize Medicare coding and reimbursement rules, (iii) be comprehensive in scope, and (iv) address fees of physicians and surgeons, hospitals, ambulatory surgical centers, ancillary services provided by other health care facilities and providers, and pharmacy and pharmaceutical services. The measure provides that certain initial fee schedule regulations shall apply uniform conversion factors of up to 150 percent of Medicare base reimbursement rates in determining reimbursement levels. The Commission is directed annually to review and revise the fee schedules, provided that if revisions address changes in inflation, the increase is capped at three percent per year. The Commission shall have an independent, peer-reviewed study conducted every two years. The measure prohibits bringing a claim for payment of charges for services rendered under the Act by a health care provider more than one year from the later of the date of service for which payment is sought or the date a medical award covering such service becomes final. Finally, the bill requires an insurer or self-insured employer, effective October 1, 2015, to either pay a medical bill or deny payment of the bill within 60 days of receiving a bill and supporting medical documentation. If the Commission finds that the self-insured employer or insurer unreasonably denied payment for medical services, it shall order payment for the services and award interest if the employee has paid for the services. Read the Bill »

Outcome

History