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Fee Alert: DWC Updates OMFS to Reflect Medicare Payment Changes

June 29, 2016 by Catherine Montgomery

Effective July 1, 2016, the Division of Workers’ Compensation (DWC) updated the Official Medical Fee Schedule (OMFS) to reflect changes in the Medicare payment system, as required by Labor Code 5307.1.  For more information, consult DIR Newsline No.: 2016-64.Fee_Alert_Header.png

DaisyBill's OMFS Calculator will incorporate the following changes, effective July 1st, to the Physician and Non-Physician Practitioner Fee Schedule:

  • Correct Coding Initiative (CCI) Physician/Practitioner Edits
  • New edits: 1,181 
  • Deleted edits: 6
  • Medically Unlikely Edits (MUE)
  • New edits: 373 
  • CMS Medicare National Physician Fee Schedule Relative Value File (RVU) RVU16C
  • No changes that affect fee reimbursement amounts

Although these updates don’t affect the calculations for determining reimbursement, the the CCI Edits and MUEs, which apply post-calculation, can affect reimbursements.

As a reminder:

  • CCI Edits occur when a combination of procedure codes violates the Correct Coding Initiative
  • Medically Unlikely Edits occur when procedure codes are assigned an incorrect number of units
  • Both CCI edits and MUEs result in $0 reimbursements, but only for the incorrectly billed procedure code.

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