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AK Workers' Comp Timely Filing for Services and Appeals Changed

Tuesday, January 26, 2016   (0 Comments)
Posted by: Sheri Ryan
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Representative Kurt Olson introduced HB 141 on 2/25/2013 in the 28th Legislative Session (2013/2014) of the Alaska State Legislature.  HB 141 was signed 6/23/2014 with an immediate effective date.

Significance of this bill - Providers now only have 180 days to submit bills for services to the Alaska Workers' Compensation Board for payment and 60 days to file an appeal for denial and/or reduction of payment. 

Sec. 2 AS 23.30.097 was amended by adding new subsections to read:

     (h) A provider of medical treatment or services may receive payment for medical treatment and services under this chapter only if the bill for services is received by the employer within 180 days after the later of 

          (1) the date of service; or

          (2) the date that the provider knew of the claim and knew that the claim related to employment

     (i) A provider whose bill has been denied or reduced by the employer may file an appeal with the board within 60 days after receiving notice of the denial or reduction.  A provider who fails to file an appeal of a denial or reduction of a bill within the 60-day period waives the right to contest the denial or reduction.  

SUMMARY - you now only have 180 days to file an AK Work Comp claim (not nine months or two years) and you now only have 60 days to file an appeal for denial or reduction of an AK Work Comp claim.  

This is of great significance regarding the time frames available for chiropractic offices to dispute EOBs paid incorrectly due to mis-interpretations of the Emergency Regulations adopted 12/1/2015.  ACS has been receiving complaints for adjusters not using the GPCI to determine payment amount, denying because CMS has not assigned an RVU to the CPT code, as well as some adjusters applying CMS payment guidelines (not fee amounts)  to procedures billed.  

In order to protect your office's ability to dispute these incorrect payments, any Alaska Work Comp claims that you feel have been denied in error, payment reduced or paid differently than according to the new RVU system enacted as of 12/1/2015 should be appealed to the Alaska Workers' Compensation Board (file for pre-hearing) immediately upon receiving the incorrect EOB.  

Sheri Ryan
ACS Executive Administrator

 

 


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