Provider eNews - January 2017 edition

Professional Provider Fee Schedule update cont.

“Incident to” billing
BWC's policy requires all providers to be credentialed and bill independently for services provided. It is important to be aware that BWC does not allow “incident to” billing. Medicare developed this terminology. In simple terms, incident to refers to the situation in which an advanced practice provider such as a nurse practitioner, provides services to a patient under the supervision of the physician, and the physician would bill for the service. Certain services rendered in the office setting are eligible for billing when qualified auxiliary personnel perform the services. Qualified auxiliary personnel are not eligible to bill directly to BWC. Therefore, they are not eligible to receive direct reimbursement. Examples of qualified auxiliary office personnel include registered or licensed practical nurses, medical assistants, technicians employed by the practice. However, BWC requires non-physician providers who are eligible for credentialing and have an independent billing identification number through BWC to bill BWC directly. He or she is not eligible for incident to billing.

Telemedicine and telephone billing codes
Telemedicine generally refers to the use of communications and information technologies for the delivery of clinical care. BWC follows the Medicare policy and pays for a limited number of services furnished by a physician or practitioner to an injured worker via a telecommunications system. For eligible telemedicine services, the use of a telecommunications system substitutes for an in-person encounter.

BWC also follows the Medicare policy that limits providers to render services through telemedicine at appropriate originating and distant sites. As a condition of payment, providers must use an interactive audio and video telecommunications system that permits real-time communication between the provider, at the distant site, and the injured worker, at the originating site. As stated, telemedicine services can replace a face-to-face patient encounter. Please note that BWC covers the use of a telephone to be billed with CPT codes 99371-99373. However, BWC does not consider this telemedicine. Therefore, the managed care organization cannot authorize a phone call to replace a face-to-face encounter. BWC will provide a Policy Alert on this topic in the next few months.

BWC Inpatient Hospital Fee Schedule annual update
BWC has revised the Inpatient Prospective Payment System (IPPS) fee schedule as specified in Ohio Administrative Code 4123-6-37.1 to adopt version 34.0 of the Medicare Severity Diagnosis Related Groups (MS-DRGs) and pricing factors as published in Medicare’s Final IPPS Final Rule. The BWC payment adjustment factor for MS-DRG and Direct Graduate Medical Education will be 112.7 percent. The payment adjustment factor for outliers will be 175.4 percent. The annual update will be effective Feb. 1, 2017.