Do you know what you are supposed to be paid for non-network workers’ compensation services according to the updated 2010 Workers’ Compensation Medical Fee Guideline?
The Texas Department of Insurance (TDI) Division of Workers' Compensation announced in early November the annual changes to conversion factors for workers' compensation medical fee guidelines for professional services, charges, and payments using the Medicare Economic Index (MEI).
"The MEI, reported as a 1.2-percent increase for 2010, is a weighted average of price changes for goods and services used to deliver physician services," according to a TDI bulletin.
For services provided in calendar year 2010, the new medical fee guideline conversion factors are $54.32 and $68.19. The conversion factor of $54.32 applies to evaluation and management services, general medicine, physical medicine and rehabilitation, radiology, pathology, anesthesia, and surgery when performed in an office.
The conversion factor of $68.19 applies to surgery performed in a health care facility.
These fee schedules do not incorporate all factors related to the Texas Department of Insurance, Division of Workers Compensation payment rules, such as policies regarding payment of consultation codes, the applicability of OPPS payment limits, or definitions of various payment terms. The source for correct information on these and other Texas worker’s compensation payment issues is the Texas Department of Insurance (Note – TDI does not give coding advice).
Note: Please use Excel to open all sheets.
The Revised 2010 Workers' Compensation fee schedule by geographic region – incorporating revisions made in the federal Affordable Care Act
The federal health reform bill, which was adopted into law on March 23rd, 2010 modified geographic adjustment factors and some relative values used in Medicare. Although the Medicare changes are effective retroactively, Texas workers’ comp rules state that "(8) Whenever a component of the Medicare program is revised, use of the revised component shall be required for compliance with Division rules, decisions, and orders for professional services rendered on or after the effective date, or after the effective date or the adoption date of the revised component, whichever is later”. Information about payment disputes can be found here: http://www.tdi.state.tx.us/wc/mfdr/index.html
The 2010 Workers' Compensation fee schedule by geographic region before revisions made in the federal Affordable Care Act.
The 2009 Workers' Compensation fee schedule by geographic region.
TMA has provided the Workers' Compensation fee schedule by geographic region. The fees for non-network and out of network payments were effective Jan. 1, 2009.
The 2008 Workers' Compensation fee schedule by geographic region.
TMA has provided the Workers' Compensation fee schedule by geographic region. The fees for non-network and out of network payments were effective March 1, 2008.