NOTICE IS HEREBY GIVEN that, pursuant to N.C. Gen. Stat. §§97-26(a) and (b) and 97-80(a), the North Carolina Industrial Commission will hold a public hearing on the amendment of the Hospital Fee Schedule for Workers’ Compensation cases (Section 14 Hospital and Ambulatory Surgical Center, North Carolina Industrial Commission Medical Fee Schedule) for 2009 and following.

The proposed billing methods are to become effective on or about July 17, 2009. The Commission solicits oral and written comments of all interested persons, firms, and organizations wishing to comment concerning any aspect of the proposed billing methods.

SUCH PUBLIC HEARING will be held on Tuesday, January 6, 2009, from 9:30 a.m. to 4:00 p.m. at the Industrial Commission Hearing Room, located on the second floor of the Dobbs Building, 430 N. Salisbury Street, Raleigh, NC, during which the Commission will hear the oral 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 Tuesday, December 30, 2008. Speakers at the public hearing are encouraged to prepare a written summary of remarks for the use of the Commission.

http://www.ic.nc.gov//

WRITTEN COMMENTS SHOULD BE FAXED TO MEREDITH HENDERSON AT (919) 715-0282 OR MAILED TO 4336 MAIL SERVICE CENTER, RALEIGH, NC 27699-4336 NO LATER THAN JANUARY 14, 2009.

The Industrial Commission proposes the following changes to the hospital fee schedule:

• The lower end cap of the DRG band for reimbursement of inpatient hospital bills will be adjusted from 77.07% to 75% of charges for hospitals other than critical access hospitals.
   
  • Critical access hospitals are defined by federal law and are the smallest hospitals in the State, located in rural areas.
• The reimbursement rate for outpatient hospital bills will be adjusted from 95% of charges to 79% of charges for hospitals other than critical access hospitals. For critical access hospitals, the outpatient reimbursement rate will be reduced from 95% to 87% of charges.
• The reimbursement rate for ambulatory surgical centers will be adjusted from 100% of charges to 79% of charges.

The payment rates proposed by the Commission for hospital outpatient, ambulatory surgical center, and hospital inpatient services are straightforward reductions in the discount levels that are used under the existing payment methodologies. There are no changes to the payment methodologies. The changes in the hospital outpatient rate and the ambulatory surgical center rate are reductions in the percentage discount off charges. The change in the inpatient lower end cap also is a reduction in the percentage discount off charges. All three reductions are based upon a recommendation of a majority of the members of the Hospital Fee Schedule Advisory Committee. The Commission and the Advisory Committee have reviewed data provided by the Workers Compensation Research Institute, the American Insurance Association, Key Risk Management Services, and the North Carolina Hospital Association in evaluating the appropriate levels for reimbursement. Based particularly on the representations of the North Carolina Hospital Association, the Commission is satisfied that the reductions in the percentage discounts off of charges proposed will reimburse hospitals and ambulatory surgical centers reasonable fees for their services and that injured workers will continue to be provided the standard of services and care intended by the Workers’ Compensation Act.

The related fiscal note certified by the Office of State Budget and Management is posted at http://www.osbm.state.nc.us/files/pdf_files/NCIC11182008.pdf.

                        S/                       
PAMELA T. YOUNG
CHAIR