North Carolina
Industrial Commission

MEMORANDUM

The North Carolina Industrial Commission continues to receive reports regarding improper reductions for outpatient hospital services. Hospitals are to bill using revenue codes on a UB-92 Form. Other than the designated non-covered revenue codes that are to be billed on a HCFA 1500, the outpatient services are to be paid at 95% of charges. Ambulatory Surgery facility charges are to be paid in full. There is no reason for requiring a hospital to provide CPT or HCPCS codes for a workers’ compensation billing, although some hospitals automatically generate these codes on their UB-92 bills. Please note, the fees for those codes do not apply for facility bills.

Companies will be held accountable for improper application of the Fee Schedule, and stand to loose their authorization to process bills. It is permissible to request medical records and itemized statements to support a UB-92 bill. It is not permissible to request coding on a bill not required by the Industrial Commission guidelines. When the wrong coding is used to process bill, the payments are reduced improperly. This costs the medical providers in lost revenue and overhead in filing appeals. Additionally, this practice could cost payors in ten percent late penalties when bills are submitted properly and not paid timely and properly.

It is advisable at this time for all companies to review practices involving hospital bills. If you have questions, please contact me at (919) 807-2614.