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Charges and payments between medical providers and sureties may be
appealed to the Industrial Commission for a binding decision.
On this page you will find:
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New Fee Schedule |
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The Idaho Industrial Commission has adopted a new rule governing payments for medical services under the
Idaho Workers' Compensation Law.
This rule is effective April 2,
2008, and is applicable to all workers’ compensation medical
services provided on or after April 2, 2008.
Click
here
to view the rule.
Questions regarding the medical fee schedule may be
directed to
Patti
Jarossy, Medical Fee Schedule Analyst.
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Announcement for
Hospitals and Ambulatory Surgery Centers |
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The Industrial Commission held informational
sessions May 5th and 6th regarding facility reimbursement. The
sessions were presented by the medical fee consultant from Ingenix,
and are available to view online.
Hospitals, ambulatory surgical centers, payors, and employers are now invited to submit
written comments on issues pertinent to facility reimbursement by
Friday, June 13, 2008.
For further information, please call Patti Jarossy,
Medical Fee Analyst, at 334-6084.
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Relative Value Units |
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The Relative Value Units file, released by the Centers for Medicare and
Medicaid services in November 2007, is available
here.
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Rules
and Forms |
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Medical fee dispute procedures are governed by the Idaho Administrative
Procedure Act (IDAPA) and the Commission's Judicial Rules of Procedure.
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Tips
and Frequently Asked Questions |
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The Commission has prepared some items to help navigate the medical fee
dispute process. Below are tips for filing a motion for approval of a
disputed charge. The Commission has also created a separate page to
answer frequently asked questions (FAQ). Click
here to view that page.
Tips for success with a motion for approval of a disputed charge:
- DO list in the motion:
- The date the bill was sent/received.
- The date the Preliminary Objection was sent/received.
- The date the Response was sent/received.
- The date the Final Objection was sent/received.
- DO check the deadlines before you send the motion.
- DO use the standard forms.
- DO itemize billings by CPT code.
- DO make sure you allege that the charges are your usual charges.
- DO provide copies of the:
- Bills (but indicate which part of the bill is in dispute)
- Preliminary Objection
- Response
- Final Objection.
- DO understand that Commission staff are legal, not medical, professionals, and that the
dispute process is a legal, not medical, forum.
- DO send copies to the other parties.
- DO indicate the dates of the documents.
- DO organize your billing information before filing.
- DON’T send in multiple copies of the same item.
- DON’T forget to fully complete a certificate of service/mailing.
- DON’T hesitate to call Commission staff before you send in the motion if you have
any questions.
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New Medical Fee Schedule Effective April 2, 2008 |
The new medical fee schedule is included in IDAPA 17.02.08 A copy may be viewed
here.
Questions regarding the new schedule may be
directed to
our
Medical Fee Schedule Analyst,
Patti Jarossy, or by calling 334-6084.
A medical fee schedule consultant from Ingenix presented
highlights of their findings on physician charges in a public hearing held in Boise on
October 15, 2007. The presentation may be viewed
here.
Idaho's new fee schedule differentiates hospitals by the number of acute
care beds. A large hospital is a facility with more than one hundred
(100) acute care beds, while a small hospital is a facility with one hundred
(100) acute care beds or less.
For a list of hospitals, and the number of beds in the facility, click
here.
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