RE: QUESTON Re: WC Fee Schedule/Rules Applied to PI Claims/Payment

[Guest guest]

(1)

Yes, per ORS 742.525, pasted below. More accurately, you’re

not allowed to charge more than the comp amount.

(2)

I assume you would be liable for an unlawful debt collection

practice if you try to get the balance for a PIP-paid/ payable date of service.

Unanswered question: if a person receives PIP benefits, which then run out, are

the charges after PIP runs out still subject to the comp fee schedule? I

assume the answer to that is no.

742.525

Provider charges. (1) Except as provided in subsection (2) of this section,

a provider shall charge a person who receives personal injury protection

benefits or that person’s insurer the lesser of:

(a) An amount that does not exceed the amount the provider charges the general

public; or

( An amount that does not exceed the fee schedules for medical services

published pursuant to ORS 656.248 for expenses of medical, hospital, dental,

surgical, ambulance and prosthetic services.

(2) For expenses of hospital services that are subject to the adjusted

cost-to-charge ratio specified for a hospital in the hospital fee schedule

published pursuant to ORS 656.248, a provider of hospital services shall charge

a person who receives personal injury protection benefits or that

person’s insurer the greater of:

(a) The amount of the hospital charges multiplied by the adjusted

cost-to-charge ratio specified for the hospital; or

( Ninety percent of the hospital charges.

Chris

T. Hill, PC

520 SW Sixth Avenue, Suite 1250

Portland, OR 97204

(503) 227-4330

chill@...

From:

[mailto: ] On Behalf Of bluepearl2001@...

Sent: Thursday, June 04, 2009 12:07 PM

Subject: QUESTON Re: WC Fee Schedule/Rules Applied to

PI Claims/Payment

Good morning,

Colleagues--

I would appreciate it if someone would take the time to clarify the extent

to which WC rules can be applied to PI cases.

I understand that the WC fee schedule is now the standard for all PI claim

payments.

What I would specifically like to know is:

1) Am I really required to write off the WC fee schedule

deductions--eat them?

2) OR are we able to ask for reimbursement from a patient or from

a patient's settlement if

there is a balance on their

PI account as a result of the WC fee schedule.

3) Is anyone being paid for cervical orthopedic pillows for

patients with cervical injury? If so, what code are you using.

If there are any attorneys on this list serve, I would appreciate an answer from

you, as well.

I really appreciate having access to this list serve group. Thank you

ahead of time for all your comments and help.

Ann , DC

[Guest guest]

(1)

Yes, per ORS 742.525, pasted below. More accurately, you’re

not allowed to charge more than the comp amount.

(2)

I assume you would be liable for an unlawful debt collection

practice if you try to get the balance for a PIP-paid/ payable date of service.

Unanswered question: if a person receives PIP benefits, which then run out, are

the charges after PIP runs out still subject to the comp fee schedule? I

assume the answer to that is no.

742.525

Provider charges. (1) Except as provided in subsection (2) of this section,

a provider shall charge a person who receives personal injury protection

benefits or that person’s insurer the lesser of:

(a) An amount that does not exceed the amount the provider charges the general

public; or

( An amount that does not exceed the fee schedules for medical services

published pursuant to ORS 656.248 for expenses of medical, hospital, dental,

surgical, ambulance and prosthetic services.

(2) For expenses of hospital services that are subject to the adjusted

cost-to-charge ratio specified for a hospital in the hospital fee schedule

published pursuant to ORS 656.248, a provider of hospital services shall charge

a person who receives personal injury protection benefits or that

person’s insurer the greater of:

(a) The amount of the hospital charges multiplied by the adjusted

cost-to-charge ratio specified for the hospital; or

( Ninety percent of the hospital charges.

Chris

T. Hill, PC

520 SW Sixth Avenue, Suite 1250

Portland, OR 97204

(503) 227-4330

chill@...

From:

[mailto: ] On Behalf Of bluepearl2001@...

Sent: Thursday, June 04, 2009 12:07 PM

Subject: QUESTON Re: WC Fee Schedule/Rules Applied to

PI Claims/Payment

Good morning,

Colleagues--

I would appreciate it if someone would take the time to clarify the extent

to which WC rules can be applied to PI cases.

I understand that the WC fee schedule is now the standard for all PI claim

payments.

What I would specifically like to know is:

1) Am I really required to write off the WC fee schedule

deductions--eat them?

2) OR are we able to ask for reimbursement from a patient or from

a patient's settlement if

there is a balance on their

PI account as a result of the WC fee schedule.

3) Is anyone being paid for cervical orthopedic pillows for

patients with cervical injury? If so, what code are you using.

If there are any attorneys on this list serve, I would appreciate an answer from

you, as well.

I really appreciate having access to this list serve group. Thank you

ahead of time for all your comments and help.

Ann , DC

[Guest guest]

No Ann you cannot balance bill the patient for the balance as the WC fee scedule is it....however, it is not a bad fee scedule compared to all other insurances.

Vern Saboe

QUESTON Re: WC Fee Schedule/Rules Applied to PI Claims/Payment

Good morning, Colleagues--I would appreciate it if someone would take the time to clarify the extent to which WC rules can be applied to PI cases. I understand that the WC fee schedule is now the standard for all PI claim payments.What I would specifically like to know is: 1) Am I really required to write off the WC fee schedule deductions--eat them? 2) OR are we able to ask for reimbursement from a patient or from a patient's settlement if there is a balance on their PI account as a result of the WC fee schedule. 3) Is anyone being paid for cervical orthopedic pillows for patients with cervical injury? If so, what code are you using.If there are any attorneys on this list serve, I would appreciate an answer from you, as well.I really appreciate having access to this list serve group. Thank you ahead of time for all your comments and help.Ann , DC

[Guest guest]

No Ann you cannot balance bill the patient for the balance as the WC fee scedule is it....however, it is not a bad fee scedule compared to all other insurances.

Vern Saboe

QUESTON Re: WC Fee Schedule/Rules Applied to PI Claims/Payment

Good morning, Colleagues--I would appreciate it if someone would take the time to clarify the extent to which WC rules can be applied to PI cases. I understand that the WC fee schedule is now the standard for all PI claim payments.What I would specifically like to know is: 1) Am I really required to write off the WC fee schedule deductions--eat them? 2) OR are we able to ask for reimbursement from a patient or from a patient's settlement if there is a balance on their PI account as a result of the WC fee schedule. 3) Is anyone being paid for cervical orthopedic pillows for patients with cervical injury? If so, what code are you using.If there are any attorneys on this list serve, I would appreciate an answer from you, as well.I really appreciate having access to this list serve group. Thank you ahead of time for all your comments and help.Ann , DC

[Guest guest]

That was exactly my understanding and so that has been my policy since the WC/PI rule change. The only reason I asked was because I received a comment from another list service DC who suggested the opposite. Just wanted to get the "rules" out....again.

Thanks again,

Ann , DC

Re: QUESTON Re: WC Fee Schedule/Rules Applied to PI Claims/Payment

No Ann you cannot balance bill the patient for the balance as the WC fee scedule is it....however, it is not a bad fee scedule compared to all other insurances.

Vern Saboe

QUESTON Re: WC Fee Schedule/Rules Applied to PI Claims/Payment

Good morning, Colleagues--

I would appreciate it if someone would take the time to clarify the extent to which WC rules can be applied to PI cases.

I understand that the WC fee schedule is now the standard for all PI claim payments.

What I would specifically like to know is:

1) Am I really required to write off the WC fee schedule deductions--eat them?

2) OR are we able to ask for reimbursement from a patient or from a patient's settlement if

there is a balance on their PI account as a result of the WC fee schedule.

3) Is anyone being paid for cervical orthopedic pillows for patients with cervical injury? If so, what code are you using.

If there are any attorneys on this list serve, I would appreciate an answer from you, as well.

I really appreciate having access to this list serve group. Thank you ahead of time for all your comments and help.

Ann , DC

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