New bills would address compounds, deadlines for authorization decisions, and more.
New bills would address compounds, deadlines for authorization decisions, and more.
The bill would require a formal fee schedule for all services provided under workers’ comp, taking effect August 28, 2026.
Healthesystems played a significant role in reshaping policy surrounding reimbursement for physician dispensing.
Initiatives for 2026 could affect medical billing, pharmacy programs, treatment guidelines, and administrative processes.
After public feedback is received at the February 19th meeting, the fee schedule is expected to take effect March 15, 2026.
Reimbursement structures have remained unchanged for over a decade, prompting regulators to push for updates.
The case will examine the Bureau of Workers’ Compensation’s use of RED BOOK for calculating AWP.
Changes will impact DME supplier services, facility outpatient hospital services, and practitioner services.
Claims exceeding $1 million in costs saw a projected home health share of medical costs reach 20.1%.
Drug classes with the most new, high-priced drugs were anti-cancer drugs, ADHD/anti-obesity drugs, and anti-inflammatory pain medications.
Effective January 1st, CARC and RARC codes will be permitted for use in EOBs, leveraging nationally recognized standards.
The fee schedule has not been updated since 2009, resulting in low reimbursement rates, which has impacted access to care.
States that base their workers’ comp fee schedules on the CMS Fee Schedule may adopt these adjustments, which go into effect January 1st.
2025 relative values for physicians will be incorporated, while NCCI medical data was reviewed to compare state trends to national trends.
The Medical Fee Guide Committee also discussed PPO practices, psychiatric IMEs, and more.
