| A. Additions to the Chiropractic Fee Schedule (effective March 1, 2001) | E. Establishment of Hospital Fees for Workers' Compensation Cases (effective January 1, 2001) |
| B. Adoption of a Durable Medical Equipment/Supply Fee Schedule (effective March 1, 2001) | F. Reimbursement for Multiple Arthroscopic Procedures (effective March 1, 2001) |
| C. Deletion of Obsolete CPT Codes (effective March 1, 2001) | G. Amendment of Industrial Commission Rule 104 (effective March 1, 2001) |
| D. Adoption of Fees for Physicians' Assistants (effective March 1, 2001) |
Inpatient hospital fees for workers compensation patients will be calculated 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 77.07% 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 77.07% 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, 2000. 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, 2000. (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, 2000.
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, 2000.
Go Back to January 16, 2001 Order Adopting These Rules
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