TO: Hospitals, Employers, Insurance Companies, Self-Insureds, TPAs
FROM: N.C. Industrial Commission (Commissioner Thomas J. Bolch, contact person)
SUBJECT: Explanation of DRG compromise
Representatives of employers, insurance carriers and selfinsurers as well as representatives of the Industrial Commission and the N.C. Hospital Association arrived at a compromise interim solution of the DRG methodology at the end of March. Under the compromise, those bills for hospital admissions from July 1, 1995, through March 31, 1996, will be handled under the DRG rules in effect in that period under the State Health Plan.
Bills for hospital admissions from 1 April 1996 through 30 June 1997 will follow the DRG methodology of the State Health Plan with the exception that they will be no lower than 90% of the itemized hospital bill and no higher than 100% of the itemized hospital bill.
Other requirements of the compromise:
GENERAL ASSEMBLY OF NORTH CAROLINA
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95RR063E ( )
Short Title: Hospital Reimbursement. (Public)
A BILL TO BE ENTITLED
AN ACT TO CHANGE THE REQUIREMENT FOR HOSPITAL
REIMBURSEMENT IN WORKERS' COMPENSATION CASES.
The General Assembly of North Carolina enacts:
Section 1. G.S. 9726(b) reads as rewritten:
"(b) Hospital Fees. -- Payment for medical compensation rendered by a hospital participating in the State Plan, except as otherwise provided herein, shall be equal to the payment the hospital receives for the same treatment and services under the State Plan, provided that such payment with respect to inpatient hospital services shall not be less than ninety percent (90%) nor more than one hundred percent (100%) of the hospital's itemized charges as shown on the UB92 claim form. A hospital's itemized charges on the UB92 claim form for workers' compensation services shall be the same as itemized charges for like services for all other payors during the period from April 1, 1996, through June 30, 1997. Payment for a particular type of medical compensation that is not covered under the State Plan shall be based on the allowable charge under the State Plan for comparable services or treatment, as determined by the Commission. Each hospital subject to the provisions of this subsection shall be reimbursed the amount provided for in this subsection unless it has agreed under contract with the insurer, managed care organization, or employer to accept a different amount or reimbursement methodology. "
Sec. 2. This act becomes effective April 1, 1996, and applies to hospital inpatient admissions occurring on or after that date. This act expires on June 30, 1997, and its expiration applies to all hospital inpatient admissions occurring on or after that date.