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2017 Fee Schedule Changes Again – Learn How to Keep Up

March 22, 2017 by Catherine Montgomery

Well, that didn’t take long. Earlier this month – only eight days after officially adopting the Quarter 1 Physician Fee Schedule – the California Division of Workers’ Compensation (DWC) issued a Newsline announcing the next wave of changes to the Official Medical Fee Schedule (OMFS).[1] Somewhat surprisingly, there are several major reimbursement changes facing California workers’ comp providers for dates of service on or after April 1, 2017. But there’s good news, too – our development team unleashed a brand new tool designed to ensure that you never miss a reimbursement change again.

As you probably know by now, calculating reimbursement amounts for workers’ comp is a laughably complicated process. Each reimbursement requires the use of one of two formulas – one for facility places of service, and one for non-facility. In turn, each formula relies on three Relative Value Units, or RVUs. For dates of service on or after April 1, 2017, the DWC uses Medicare’s Quarter 2 RVU files. You may download these files from the Medicare website by following this link.

We discovered a number of big changes in our analysis of the April 1 fee schedule changes. Most significantly, a series of recently-added Physical Therapy and Occupational Therapy codes saw an increase, with the Occupational Therapy codes increasing by over 20%.

Procedure Code

Description

Non-Facility Reimbursement as of March 1, 2017 (n/f)

Non-Facility Reimbursement as of April 1, 2017 (n/f)

Reimbursement Change Percent

97161

Pt eval low complex 20 min

$109.69

$110.73

+0.94%

97162

Pt eval mod complex 30 min

109.69

110.73

+0.94%

97163

Pt eval high complex 45 min

109.69

110.73

+0.94%

97165

Ot eval low complex 30 min

106.05

127.35

+20.08%

97166

Ot eval mod complex 45 min

106.05

127.35

+20.08%

97167

Ot eval high complex 60 min

106.05

127.35

+20.08%

97168

Ot re-eval est plan care

70.43

84.97

+20.64%

The April physician fee schedule update also includes Correct Coding Initiative and Medically Unlikely Edits. The former occurs when two procedure codes are incorrectly billed together. Medically Unlikely Edits (MUEs) occur when an erroneous number of units is assigned to a single procedure code. Both CCI edits and MUEs result in a $0 reimbursement only for the incorrectly billed procedure code, so it’s important to keep up with these changes.

DaisyBill’s OMFS Calculator, part of our new Work Comp Wizard, automatically calculates reimbursements using the most recent RVU files and conversion factors and incorporating CCI edits and MUEs. To make accurate billing even easier, we just unveiled Physician Fee Schedule Alerts, an all-new feature designed to help your bottom line.

Physician Fee Schedule Alerts allow you to register your most frequently-used codes in DaisyBill. Any time the DWC issues an adjustment to the OMFS, you’ll receive an instant email alert noting any changes to your favorite codes. Work Comp Wizard subscriptions are just $49 per month, come with a free three-trial, and are cancellable at any time. You can learn more on our website.


To learn more about the Work Comp Wizard, and to try our new Physician Fee Schedule Alerts, sign up for a three-day trial below. You’ll gain instant access to the new fee schedule for any date of service on or after April 1, 2017. Should you ever need old reimbursements, simply enter a date of service prior to April 1.

Try the Daisybill Work Comp Wizard


[1] Full text of the DWC announcement here.

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