Health Care Services Rules (Effective 03/15/18)

Rules medical providers need to know when billing workers’ compensation.

New Health Care Services Rules were released by the WCA with an effective date of 03/15/18. We encourage all medical providers to familiarize themselves with these rules when billing workers’ compensation insurance.

Michigan law requires medical providers accept payment based upon a fee schedule. This is referred to as “cost containment” and all charges must be submitted on a proper claim form. Here are some highlights to know to ensure payment.

A practitioner shall submit charges on the CMS1500 claim form. A hospital billing for a practitioner service shall submit charges on a CMS 1500 claim form. A hospital-owned occupational or industrial clinic, or office practice shall submit charges on the CMS 1500 claim form.

A pharmacy, other than an inpatient hospital, shall submit charges on an invoice or an NCPDP Workers Compensation/Property & Casualty Universal Claim Form. A doctor of dentistry shall submit charges on a standard dental claim form approved by the American Dental Association. Ancillary service charges shall be submitted on the CMS 1500 claim form for durable medical equipment and supplies, L-code procedures, ambulance, vision, and hearing services. Charges for home health services shall be submitted on the UB-04 claim form.

If the provider sends a properly submitted bill to a carrier and the carrier does not respond within 30 days, and if a provider sends a second properly submitted bill and does not receive a response within 60 days from the date the provider supplied the first properly submitted bill, then the provider may file an application with the agency for mediation or hearing.

We recommend contacting a workers’ compensation attorney if medical bills go unpaid. These cases are usually taken on contingency and there is no attorney fee unless a recovery is obtained.

Michigan Workers Comp Lawyers never charges a fee to evaluate a potential case. Our law firm has represented injured and disabled workers exclusively for more than 35 years. Call (844) 201-9497 for a free consultation today.

Related information:

WCA: Health Care Services Rules, Manuals & Fees

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