DWC Posts Adjustments to Official Medical Fee Schedule

This is what we live for! At the end of March, the Division of Workers’ Compensation (DWC) posted an order adjusting the Official Medical Fee Schedule (OMFS) to conform to changes in the Medicare payment system. And your workers’ comp billing and CPT codes need to adjust accordingly. The easiest solution? Outsource your medical billing to the workers’ comp billing experts: MBC Systems.

These adjustments will require very detailed changes to how physicians are reimbursed. Our dedicated legal team has years of expertise and experience with workers’ compensation cases and is always up to date on the frequent changes in workers’ comp legislation.

The Physician and Non-Physician Practitioner Fee Schedule update Order adopts the three following Medicare changes:

CMS’ Medicare National Physician Fee Schedule Relative Value File RVU18B April 1, 2018 quarterly update

This update refers to the associated relative value units (RVUs), a fee schedule status indicator, and various payment policy indicators needed for payment adjustment (i.e., payment of assistant at surgery, team surgery, bilateral surgery, etc.) of more than 10,000 physician services.

Here’s just a glimpse of the new math:

2018 Non-Facility Pricing Amount =
[(Work RVU * Work GPCI) +
(Non-Facility PE RVU * PE GPCI) +
(MP RVU * MP GPCI)] * Conversion Factor (CF)

National Correct Coding Initiative Physician/Practitioner Services CCI Edits April 1, 2018 quarterly update

This quarter, the CMS issued 187 procedure to procedure (PTP) edits to the NCCI. At MBC Systems, we implement these changes immediately and seamlessly to ensure accurate CPT coding and prompt payment to our clients.

National Correct Coding Initiative Medically Unlikely Edits April 1, 2018 quarterly update

The CMS developed Medically Unlikely Edits (MUEs) to reduce the paid claims error rate for Part B claims. An MUE for a HCPCS/CPT code is the maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service. This update includes 91 new edits and removes 8 previous edits.

The order adopting the OMFS adjustments is effective for services rendered on or after April 1, 2018 and can be found on the DWC website.

If the complexity of workers’ comp medical billing is costing your practice more time and money than you can stomach, consider outsourcing to MBC Systems. In over 25 years of medical billing we have never had a practice that didn’t see single if not double-digit improvements in their bottom line.

If you need help with Workers Comp Billing one call will solve it all: 1-949-863-0022.