Print Page   |   Contact Us   |   Sign In   |   Register
News & Press: State News

NEW AK Workers' Compensation Fee Schedule effective 12/1/2015

Tuesday, December 22, 2015   (0 Comments)
Posted by: Sheri Ryan
Share |

Alaska Workers' Compensation
Medical Fee Schedule

Effective:  December 01, 2015  - New rates would be based on CMS Physician Fee Schedule 2015B effective July 1, 2015 and after.    Anticipated date of release of 2016 CMS rates = 02/16/2016.  
  
The Department of Labor and Workforce Development adopted emergency regulations to establish a medical fee schedule for medical services and treatment provided to injured workers to take effect December 1, 2015 and expire March 1, 2016 unless made permanent by the adopting agency. Online Public Notice  

Emergency Regulation

What does this mean?  It means the old Ingenix Alaska Workers' Comp Fee Schedule is out the door and a new method of determining fees for all healthcare providers is in - Resource-Based Relative Value Scale (RBRVS).  

The State of Alaska will NOT be issuing a new fee schedule at this time so here's how to determine the new AK Work Comp fees for chiropractic services.  Go to the CMS Physician Fee Schedule 2015B - (MPFS)  This is the CMS fee schedule currently in effect - July 1, 2015 and after.  Look up your CPT code.  

  1. Select a Year - 2015B
  2. Type of Info - Relative Value Units
  3. HCPCS - Single or List
  4. Modifier - Global, unless looking up a radiology code, then choose All Modifiers
  5. Find the Work RVU, Non-Facility PE RVU, and MP RVU for your particular code and plug in to the following equation.  PE=practice expense; MP=Malpractice 

Payment = [(Work RVU * Work GPCI) + (PE RVU PE GPCI) + (MP RVU * MP GPCI)X Conversion Factor 

Alaska GPCI are as follows:

Work GPCI = 1.5

PE GPCI = 1.107

MP GPCI = 0.712

Say what??!!  Here's an example on how to calculate CPT 98940 CMT 1-2 Regions.  

Payment = [(.46 times 1.5) + (.32 times 1.107) + (.01 times 0.712)] x 80

Payment = [0.69 + 0.35 + 0.01] x 80

Payment = 1.05 x 80

Payment  = $84.00

Want an easier way to get the NEW AK Work Comp Fee Schedule?  Renew your ACS Membership for 2016 and we'll SEND YOU the most commonly used chiropractic related CPT codes!  

Here's highlighted emergency regulations that effect chiropractic - this is VERY condensed - see Emergency Regulation for the entire Adoption Order.  

8 AAC 45.083.  Fees for medical treatment and services.  (a) A fee or other charge for medical treatment or service provided on or after December 1, 2015, may not exceed the fee schedules set out in this section.  

     (b) For medical services provided by physicians under the Alaska Workers' Compensation Act, the following conversion factors shall be applied to the total facility or non-facility Relative Value Unit in the Resource-Based Relative Value Scale, established by the Centers of Medicare and Medicaid Services, as amended, in effect at the time of treatment or service.  Medical service or treatment shall be identified by a code assigned to that treatment or service in the latest edition of the Current Procedural Terminology, published by the American medical Association, as amended.

          (1)  The conversion factor for evaluation & management is 80.

          (2)  The conversion factor for medicine (excluding anesthesiology) is 80.

          (3)  The conversion factor for surgery is 205.

          (4) The conversion factor for radiology is 257.

          (5) The conversion factor for pathology and laboratory is 142.

          (6) The relative value for Current Procedural Terminology code 97545 shall be 3.41, and relative value for Current Procedural Terminology code 97546 shall be 1.36.  

     (c) The conversion factor for anesthesiology is 121.82, which is multiplied by the base and time units for each Current Procedural Terminology code established in the Relative Value Guide, as amended, published by the American Society of Anesthesiologists.  

     (d) For supplies, materials, injections, and other services and procedures coded under theHealthCare Common Procedure Coding System, the following multipliers shall be applied to the fee schedules established by the Centers for Medicare and Medicaid Services, as amended, in effect at the time of treatment or service.  

          (1) Pathology & Clinical Lab, Centers for Medicare and Medicaid Services x 6.33.

          (2) Durable Medical Equipment Centers for Medicare and Medicaid Services x 1.84.  

.................................

     (g) The maximum allowable reimbursement for medical services that do not have current Centers for Medicare and Medicaid Services, Current Procedural Terminology, or HealthCare Common Procedure Coding System ​codes, a currently assigned Centers for Medicare and Medicaid Services relative value, or an established conversion factor shall be the lower of 85 percent of billed charges, the charge for the treatment or service when provided to the general public, or the charge for the treatment or service negotiated by the provider and the employer.  

...................................

     (j) The following billing and payment rules shall apply for medical treatment or services provided by physicians.

          (1) Providers and payers shall follow the billing and coding rules, as amended, in effect at the time of treatment, as established by the Centers for Medicare and Medicaid Services and the American Medical Association, including the use of modifiers.  The procedure with the largest Relative Value Unit will be the primary procedure and will be listed first on the claim form.  Specific modifiers shall be reimbursed as follows:

          (2) Modifier 50:  Reimbursement shall be 100 percent of the fee schedule amount or the lesser of the billed charge for the procedure with the highest Relative Value Unit.  Reimbursement shall be 50 percent of the fee schedule amount or the lesser of the billed charge for the procedure for the second and all subsequent procedures.  

          (3) Modifier 51:  Reimbursement shall be 100 percent of the fee schedule amount or the lesser of the billed charge for the procedure with the highest Relative Value Unit rendered during the same session as the primary procedure.  Reimbursement shall be 50 percent of the fee schedule amount or the lesser of the billed charge for the procedure with the second highest Relative Value Unit and all subsequent procedures during the same session as the primary procedure.

......................................

          (8) Providers and payers shall follow National Coding Initiative edits established by the Centers for Medicare and Medicaid Services and the American Medical Association, as amended, in effect at the time of treatment.  When there is a billing rule discrepancy between National Council on Compensation Insurance edits and the American Medical Association Current Procedural Terminology Assistant, American Medical Association Current Procedural Terminology Assistant guidance governs.  

.............................................

     (l) For medical treatment or services provided by other providers, the maximum allowable reimbursement for medical services provided by providers other than physicians, hospitals, outpatient clinics, or ambulatory surgical centers, shall be the lower of 85 percent of billed charges, the fee or charge for the treatment or service when provided to the general public, or the fee or charge for the treatment or service negotiated by the provider and the employer.  

Medicare Physician Fee Schedule ICN 006814 December 2014

Noridian Health Care Solutions Jurisdiction F (AK) Medicare Physician Fee Schedule

ADDENDUM  E. FINAL CY 2015 GEOGRAPHIC PRACTICE COST INDICES (GPCIs) BY STATE AND MEDICARE LOCALITY*- scroll down the page to Downloads - CY 2015 PFS Final Rule Addendums.  Download zip file, open, and select Addendum E


Community Search
Sign In


Latest News
Calendar

8/29/2018
ACS Radiology Club 08/29/2018 - Anchorage

8/30/2018
ACS Radiology Club 08/30/2018 - Valley

10/4/2018 » 10/7/2018
ACS 2018 Convention

10/24/2018
ACS Radiology Club 10/24/2018 - Anchorage

Alaska Chiropractic Society, PO Box 111507, Anchorage, AK  99511-1507 
    
Phone: (907) 903-1350   Fax:  (907) 770-3790   Email:  info@akchiro.org