Topics covered included recent MTUS updates, the pharmacy fee schedule update, UR and IMR updates, and more.
Topics covered included recent MTUS updates, the pharmacy fee schedule update, UR and IMR updates, and more.
Public comments will be accepted on the current fee schedule until September 7th.
Recommended changes will be reviewed by the WCB and MSRC on August 22nd, with final adoption expected in October, and taking effect in 2026.
The 2025 Optum RVPs for medical services and treatments will be adopted, but with current conversion factors.
Medical costs went up 8% in 2024, driven by increased utilization, fee schedule inflation, and growth in medical-legal services.
The Office of Administrative Law informed the DWC that seven areas of the proposed update required additional clarification or public notice.
The proposed changes would impact reimbursement rates, telehealth services, and much more.
The meeting covered fee schedule policies impacting physician-dispensed medication, electronic delivery for EOBs, and more.
The next meeting in October will deliver an expanded formulary list, with a review of the top five to ten exempt drugs based on utilization.
Among other updates, Wisconsin will implement a hospital fee schedule by July 1, 2027.
The proposed changes will be discussed further in the next meeting on July 18th.
Effective July 1st, fee schedule adjustments can be made by the Workers’ Compensation Commission without revenue neutrality.
The study compares workers’ comp fee schedules for professional services to Medicare rates within 44 states, accounting for 41% of medical costs.
Fee schedule clarity and defined reimbursement caps were discussed as ways to reduce ambiguity and prevent payment disputes.
The DIR must adopt the ODG formulary by July 1, 2027.
