A Pennsylvania appellate court ruled that a distributor of Durable Medical Equipment (DME) does not qualify as a “healthcare provider” under the Workers’ Compensation Act and therefore cannot use the state’s medical fee review process to dispute reimbursement.
Changes were made to the Medically Unlikely Edits (MUEs) for Practitioner Services, DME Supplier Services and Outpatient Hospital Services.
In a February 19th special meeting, the Board approved new rules and addressed confusion regarding resource materials
Prolonged licensure pauses risk reducing interpreter availability and disrupting access to care.
Under the proposal, the BWC would cover purchases through their surplus fund if the need stems from an allowed injury or occupational disease.
This workshop will cover rules around panel provider lists, delegating follow-up care to physician assistants, and other clerical matters.
Claims exceeding $1 million in costs saw a projected home health share of medical costs reach 20.1%.
Average medical equipment costs increased 87% from 2012-2024, with medical equipment representing 8.3% of total workers’ comp medical spend.
Considering recent and upcoming changes to the procurement of these services, both states have published bulletins to clarify procedures.
The presence of psychosocial risks causes functional scores to decrease 33% for workers’ comp patients with shoulder injuries.
The adjustment aims to address longstanding underpayment for E&M services, as low reimbursement has contributed to provider shortages.
The proposed changes will be discussed further in the next meeting on July 18th.
The extension will allow sign language interpreters with temporary licenses to continue providing services through June 30, 2026.
Medically unlikely edits were updated across DME, outpatient hospital services, and more.
The cost of interpreter services now surpasses prescription drug expenses, which has sparked much concern across different stakeholders.
