Re: W/C Issues

October 23, 1998

Jim,

1. Every state has it's own workcomp statute, rules, and fee schedule.

Consequently when you accept an injured worker from Massachusetts

it's up your office to learn the " rules " , fee schedule, documentation

requirements, etc.

from that State. It's the State's rules that prevail, not the carriers.

2. Again, each state can do as it pleases.

Many state comp systems create their own " local " codes in lieu of CPT codes,

and can regulate which providers have access to the codes.

Next time, try calling the states' APTA Chapter office. They can put you in

touch with someone

who understands the workcomp system, and could save you a lot of hassles.

Rick Shutes

At 02:29 PM 10/22/98 EDT, you wrote:

>We have a patient who was injured in Massachusetts on the job. He then moved

>to Iowa. We are treating him and recently received the first Explanation of

>Benefits for his service. The payments were made according to the

>Massachusetts Worker's Compensation Fee Schedule Guideline. We would not

>complain if the payment were reasonable, however, the payment translates into

>about $20-30 for an hours worth of services. There are two issues that I am

>looking for comment on:

>

>1. How legal is it for an insurer to pay for an out of state treatment on

the

>basis of an injury incurred in another state.

>

>2. Our CPT codes were altered from 97700 series to 178000 series. The

>medical review company (CorVel) indicated that the 97700 series is for

>treatments provided by a doctor's office, the other series represents

>therapists in private practice.

>

>Any and all comments will be appreciated.

>

>Thank You,

>Jim Hall

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