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2013 SESSION

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HB 1612 Workers' compensation; fee schedule for medical care services and prompt payment.

Introduced by: Timothy D. Hugo | all patrons    ...    notes | add to my profiles

SUMMARY AS INTRODUCED:

Workers' compensation; fee schedule for medical care services and prompt payment. Limits the pecuniary liability of an employer for medical, surgical, and hospital services provided on or after October 1, 2014, 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 Workers' Compensation Commission is directed to promulgate regulations establishing medical care fee schedules governing all medical care services rendered pursuant to the Virginia Workers' Compensation Act. The schedules shall become effective on October 1, 2014. The bill requires the medical care fee schedule regulations to (i) be comprehensive in scope, (ii) be based on Medicare where applicable, (iii) utilize Medicare coding and reimbursement rules, and (iv) address fees of physicians and surgeons, hospitals, ancillary services provided by other health care facilities and providers, pharmacy and pharmaceutical services, and utilization review issues and procedures. The Commission is required to review the fee schedules annually and when appropriate revise them. The measure also requires an insurer or self-insured employer, effective October 1, 2014, 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 with interest.


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