New Health Care Services Rules from the Workers Compensation Agency (WCA) will go into effect starting January 9th, 2019. These new rules cover the proper means of billing workers compensation, specifically regarding billing form accuracy standards and timeframes all medical providers must abide. The CMS 15500 claim form, the NCPDP Workers Compensation/Property & Casualty Universal Claim Form, and the UB-04 claim forms are to be the three primary forms on which medical providers will be able to submit charges according to the new Health Care Services Rules. The WCA warns all medical providers to become familiar with these new rules as soon as possible to ensure that all medical bills can be paid on time and by the correct means.
CMS 1500 forms will be the standard form for all hospital-owned occupational clinics, practitioners, hospitals responsible for billing for practitioners, office practices, and industrial clinics – as well as for ancillary services charges, like hearing and visions services, L-Code procedures, ambulance services, medical equipment, and other recognized medical supplies. NCPDP Workers Compensation/Property & Casualty Universal Claim Forms will be required for all pharmacies, with an exception for inpatient hospitals; however, in some cases, traditional invoices may still be used. US-04 claim forms will be the standard method of billing for all home health service charges. All doctors of dentistry shall continue to submit charges on traditional dental claim forms pre-approved by the American Dental Association.
If a medical provider submits a bill to a carrier correctly according to these new standards and is not responded to within a 30-day period, the medical provider must submit a second bill. If the second bill is not responded to within an additional 30-day period, totaling 60 days without reciprocation, a medical provider may request a hearing or mediation by filing an application through the agency.
If all attempts to settle your outstanding bills fail, legal intervention may be necessary. Workers compensation attorneys, like ours at Esper Aiello Law Group, can help you fight to receive the compensation you are rightfully owed. And best of all, most cases such as these will not cost you anything unless restitution is retrieved. For clarification in regards to any of the new Health Care Services Rule from the Workers Compensation Agency, or to seek guidance in your pursuit for your legally owed restitution, we encourage you to put your trust in our exceptionally qualified workers compensation attorneys at Esper Aiello Law Group, today. Call us, today, at 313.964.4900 or fill out the form in the sidebar or on our contact page, and learn more about how we can help you.