Effective January 1st, CARC and RARC codes will be permitted for use in EOBs, leveraging nationally recognized standards.
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.
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.
