Fee Alert: Series of Changes to Work Comp Fee Schedules
To determine reimbursements for Physician services rendered in 2016, the Division of Workers’ Compensation (DWC) adopted three different Physician Fee Schedules since January 1, 2016:
- For dates of service 1/1/2016 through 3/31/2016, the DWC retroactively changed the 2016 Physician Fee schedule by retroactively adopting two different CMS RVU files on 1/20/2016 and 4/12/2016.
- For dates of service on or after 4/1/2016 the DWC adopted new conversion factors and a new CMS RVU file.
Confused? Below see a handy reference table which lists all of the 2016 Physician Fee Schedule reimbursement changes. There's five total, as the DWC announced some some of the changes in 2015.
daisyBill’s billing software and calculator software is already up-to-date with these reimbursement changes. Below the reference table, see the new reimbursement for CPT 99214.
Stop scrambling when the OMFS changes, to instantly determine the new reimbursement amounts, sign up for a free trial of daisyBill’s OMFS Calculator.
2016 Physician Fee Schedule Changes
Newsline Date |
Newsline No. |
Newsline Title |
CMS Files Adopted |
Dates of Service |
4/12/2016 |
• The February 26, 2016 Acting Administrative Director Order adopts the revised Medicare National Physician Fee Schedule Relative Value File PPRRVU16_V0122, which supersedes PPRRVU16_V0105 for services rendered on or after January 1, 2016. At the time the adjustment was posted, however, the DWC inadvertently did not issue a newsline announcing adoption of the revised RVU16A file pursuant to the February 26, 2016 Order. • CMS’s Medicare National Physician Fee Schedule Relative Value File PPRRVU16_V0122 is applicable for services rendered on or after January 1, 2016 through March 31, 2016. The February 26, 2016 Acting Administrative Director Order can be found on the DWC website. |
RETROACTIVE 1/1/2016 - 3/31/2016 |
||
4/4/2016 |
• The April 1, 2016 quarterly update to the Practitioner Services Medically Unlikely Edits • The April 1, 2016 CMS’ Medicare quarterly update to the National Correct Coding Initiative Practitioner PTP Edits • The April 1, 2016 quarterly update to the Medicare National Physician Fee Schedule Relative Value File (RVU file) RVU16B • OMFS Physician Services/Non-Physician Practitioner services Conversion Factors adjusted for MEI and Relative Value Scale adjustment factors are updated and adopted as follows: Anesthesia 28.8003 Surgery 48.1743 Radiology 47.4332 All other services 42.4361 |
4/1/2016 - Current |
||
1/20/2016 |
• The Administrative Director has adopted the revised RVU file for services rendered on or after January 1, 2016. • Newsline references,§ 9789.19 Update Table: Effective 1/1/16 RVU File PPRRVU16_V1110_V2 replaced by PPRRVU16_V0105. • CMS RVU16A zip file does not list PPRRVU16_V0105 available for download; only PPRRVU16_V0122 is listed by CMS. |
RETROACTIVE 1/1/2016 - 3/31/2016 |
||
12/17/2015 |
• National Correct Coding Initiative Practitioner Procedure to Procedure Code Edits for 2016 • National Correct Coding Initiative Medically Unlikely Edits for 2016 • Place of Service Code revisions for hospital outpatient departments (adoption of new POS code 19 Off Campus-Outpatient Hospital, restriction of current POS Code 22 Outpatient Hospital to pre-2016 dates of service, adoption of revised POS Code 22 On Campus-Outpatient Hospital) |
1/1/2016 |
||
11/30/2015 |
Adopts CMS’ Medicare National Physician Fee Schedule Relative Value File (RVU file) RVU16A and related files |
1/1/2016 |
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