The Medical Fee Guide Committee also discussed PPO practices, psychiatric IMEs, and more.
The Medical Fee Guide Committee also discussed PPO practices, psychiatric IMEs, and more.
Fee schedule rates haven’t changed since 2009, and the low rates have discouraged provider participation.
A small group of prescribers and out-of-network pharmacies are driving utilization of costly drugs with affordable alternatives.
Advocacy efforts by Healthesystems helped create a prior authorization for 300mg ibuprofen, as other cost-effective doses are readily available.
The EOHHS hopes to understand how current rates affect workers’ comp coverage, access to care, quality of care, and injured worker experience.
Public comments regarding fee and payment rules, medical services, and managed care organizations must be submitted by September 30th.
The meeting will take place October 2nd and presents an opportunity to influence how topicals are regulated in the state workers’ comp system.
Provider EORs would require contract-specific info. Not providing a requested contract in 30 days allows bills to be reprocessed at full fee schedule rates.
The changes are effective October 1, replacing the 2025 Q3 versions.
The report reviews how changes to CMS reimbursement rules may impact medical costs in workers’ comp.
Discussions centered around the proposed medical fee schedule, particularly the Medicare negotiated pricing for pharmaceuticals.
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.
