By: Jennifer Smith, Esq.
The 2018 Georgia Workers’ Compensation Fee Schedule has just been released (the fee schedule is updated annually and published every April) and the most significant change is that the first Dental Fee Schedule is now available. In addition, every year there are typically increases in reimbursement amounts in general as well as changes in guidelines or coding. Below are some of the changes in the 2018 schedule. For a complete list from the State Board website, click here.
- FCE reimbursement increase: Although the total amount for the FCE cannot exceed $800.00, which remains unchanged from 2017, the FCE is billed in 15 minute increments which increased from $48.96 in 2017 to $57.00 in 2018.
• Home Health Services reimbursement increase: Reimbursement amounts for all home health services increased in 2018. The reimbursement amounts are based on the licensure of the provider of the services and also include non-credentialed care, including family members. For instance, the hourly rate on a weekday increased from $51.36 to $51.98 for a registered nurse (RN) and from $25.26 to $25.56 for a certified nurse assistant (CNA). The hourly rate for a family member increased from $10.62 to $10.75, with a maximum of 12 hours per day.
• IME codes changed, but reimbursement amounts stay the same: There are different codes for IMEs, depending on what the provider is billing. “IME01” is to be used for the prepayment of the first two hours, and “IME02” is used for subsequent hours beyond the 2-hour prepayment. The no-show fee of $150 is billed under “IME03”.
As indicated, reimbursement for IMEs remains the same: $600 per hour and a prepayment allowed for two hours, or $1,200.00, pursuant to Board Rule 202(b). Each additional 15 minutes beyond the first hour is reimbursed at $150.00. On a practical note, even though the no-show fee is only $150.00, many providers charge significantly more than that (just as some providers charge more than $1,200 for the IME).
• Transportation – Ambulance and Air Services reimbursement increase: Reimbursement for all ambulance and air services increased. For instance, non-emergency ambulance service transport in urban areas increased from $425.55 to $430.66.
In addition to the above changes, below are some general reminders regarding the Fee Schedule:
o Prescriptions must be generic unless “brand necessary” is written in the doctor’s handwriting.
o Reimbursement will be the average wholesale price (AWP) plus a dispensing fee.
- Payment of bills
o Payment is required within 30 days and there are penalties if payment (or an explanation of denial/reduction) is not made within 30 days, pursuant to O.C.G.A. 34-9-203.
o Medical records should be attached to the bill and should be legible, although a provider only has to send medical records and the bill once. Additional copies can be billed to the insurer.
o The medical provider cannot charge for a missed appointment except for an IME.
- Special reports
o Reimbursement for “special reports” (beyond what is in the standard reporting forms) is $60.00.
- Deposition testimony
o The fee schedule for a deposition is the same as for an IME: $600.00 for the first hour and $150.00 for every 15 minutes thereafter.