Changes were made to the Medically Unlikely Edits (MUEs) for Practitioner Services, DME Supplier Services and Outpatient Hospital Services.
Changes were made to the Medically Unlikely Edits (MUEs) for Practitioner Services, DME Supplier Services and Outpatient Hospital Services.
Originally meant to address compound medications, the bill has been expanded to create limitations for physician dispensing.
In a February 19th special meeting, the Board approved new rules and addressed confusion regarding resource materials
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.
