Oregon Proposes Changes to Workers’ Compensation Medical Rules

March 25, 2009

Oregon’s Department of Consumer and Business Services, Workers’ Compensation Division, has proposed changes to the state’s medical fee schedules, which overall would increase payments to medical service providers and result in a corresponding cost increase for insurers, DCBS said. The proposed changes are updates required by ORS 656.248, and would make other changes consistent with the director’s responsibilities under ORS 656.26(4).

The proposed rules address adoption of updated medical fee schedules and resources for the payment of health care providers; good cause exception for late billing; compensability of cervical artificial disc replacements; requirement for procedural codes on hospital bills; the basis for the director to exclude rural hospitals from imposition of the adjusted cost/charge ratio; billing procedures for ambulatory surgical centers; and payment of physician assistants or nurse practitioners who perform or assist in surgery, according to the notice of proposed rulemaking.

The proposed rule would also provide procedures for giving worker lists of eligible attending physicians in a managed care organization. “Allowing insurers to refer workers to Web sites to look up eligible attending physicians, instead of providing printed lists should reduce insurers’ printing and mailing costs,” John Shilts, Workers’ Compensation Division administrator stated in the proposed rulemaking. Workes who can access online information also will benefit from having more updated physician lists, he indicated.

“Because the agency does not know how many insurers and workers will use the new procedures, the agency cannot estiamte savings, but the effect should be positive for insurers,” the WCD stated.

A hearing on the proposed rules will be held at 10 a.m. on April 21, 2009. For information on the proposed rules and hearing information, visit www.cbs.state.or.us/external/wcd/policy/rules/rules.html#proprules.

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