North Carolina
Industrial Commission

Public Notice of Rule-Making by the North Carolina Industrial Commission to Establish Hospital Fees for Workers' Compensation Cases

NOTICE IS HEREBY GIVEN that, pursuant to N.C. General Statute Sections 97-26(b)(3), 97-26(a), and 97-80(a), the North Carolina Industrial Commission will consider amending its fee schedule for hospital inpatient bills to become effective September 1, 1999. The Commission solicits the comments of all interested persons, firms, and organizations who wish to comment concerning any aspect of the amended fee schedule. Copies of the amended fee schedule may be obtained by any interested person by addressing a request to the address below. COPIES MAY ALSO BE OBTAINED ON THE INDUSTRIAL COMMISSION'S WEBSITE:

http://www.comp.state.nc.us/ncichome.htm

The amendment to the inpatient hospital fee schedule is designed: TO ESTABLISH a method of calculating inpatient hospital fees in workers' compensation cases pursuant to N.C. General Statute Section 97-26(b)(3) based upon Diagnostic Related Groupings and the inpatient hospital bill (UB-92) for the period beginning with adoption and extending until a successor method is adopted pursuant to N.C. General Statute Section 97-26(b)(3).

The Commission requests written comments on the amendment. In addition, there will be a public hearing held on the 22nd day of July, 1999, at 10:00 a.m., in Room 2149, the Utilities Commission Hearing Room, Dobbs Building, 430 North Salisbury Street, Raleigh, N.C., during which the Commission will hear the verbal comments of persons scheduled to speak. Those desiring to make an oral presentation, not to exceed 10 minutes in length, should submit a request on or before 21 July 1999. Speakers at the public hearing are encouraged to prepare a written summary of remarks for the use of the Commission.

WRITTEN COMMENTS, REQUESTS FOR COPIES AND REQUESTS FOR ORAL PRESENTATIONS SHOULD BE ADDRESSED TO COMMISSIONER THOMAS J. BOLCH AT 430 NORTH SALISBURY STREET, RALEIGH, NC 27611. COPIES MAY ALSO BE OBTAINED ON THE INDUSTRIAL COMMISSION'S WEBSITE:

http://www.comp.state.nc.us/ncichome.htm

WRITTEN COMMENTS SHOULD BE FAXED OR MAILED NO LATER THAN AUGUST 2, 1999.

The amendment to the method of calculating inpatient hospital fees is as follows: Diagnostic Related Groupings (DRG's) will be utilized subject to the following maximum and minimum. The maximum will be 100% of the hospital's itemized charges as shown on the UB-92 claim form. The minimum shall be 81.35% of the charges as shown on the UB-92 claim form. DRG's falling within the band limited by the maximum and minimum will be approved at whatever they are.

The 81.35% minimum was established by (a) reviewing data from the State Health Plan to ascertain the aggregate hospital itemized charges and aggregate amounts authorized for payment by the State Plan (including payments actually made by the State Plan and deductible, coinsurance, or other amounts for which the patient/insured may have been liable) for inpatient hospital claims paid to participating hospitals by the State Plan during the fiscal year ended June 30, 1998. The Commission then utilized the data described in the preceding sentence to calculate the extent, if any, to which aggregate State Plan authorized payments were less than aggregate charges on inpatient hospital claims paid by the State Plan during the fiscal year ended June 30, 1998. (b) The Commission then calculated aggregate hospital itemized charges and aggregate payments authorized by the Commission on all inpatient hospital workers' compensation claims approved for payment by the Commission during the fiscal year ended June 30, 1998.

Based on the data described in subdivisions (a) and (b) immediately preceding, the Commission established a minimum percentage that will result in a payment rate for inpatient workers' compensation cases that in the aggregate bears a percentage relationship to hospital itemized charges that is equal to the State Plan relationship between aggregate payments authorized and aggregate itemized charges for claims paid by the State Plan during the fiscal year ended June 30, 1998.

This 26th day of May 1999.

                              S/                              
J. Howard Bunn Jr.
Chairman
North Carolina Industrial Commission

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N.C. Industrial Commission · 4319 Mail Service Center · Raleigh, NC 27699-4319
Main:  (919) 733-4820  ·   Fax:  (919) 715-0282  ·   BBS:  (919) 715-5920
Internet Address:  http://www.comp.state.nc.us/