Newsline No. 29-07
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April 19, 2007

Division of Workers' Compensation reminds claims administrators that reimbursement rates for evaluation and management procedures went up in February

The Division of Workers' Compensation (DWC) is reminding claims administrators that the final regulations increasing reimbursable fees for evaluation and management (E&M) procedures became effective Feb. 15, 2007. Claims administrators were required to begin reimbursing doctors at the new rates at that time. The DWC Audit Unit is receiving complaints about underpayment for these office visits and will examine files for problems in this area when conducting audits.

"Claims administrators should go back and review payments for these services to make sure they are in compliance with the new fee schedule for services on or after Feb. 15," said DWC Audit Unit Manager Bob Walensa. "They should also pay interest and penalties on claims they find were underpaid if appropriate."

The DWC published formal notice of the rule change in the California Notice Register on Friday, Dec. 29, 2006 and a public hearing on the regulations was held Jan. 24, 2007. The final regulations were filed with the Office of Administrative Law (OAL) on Feb. 13 and became effective Feb. 15. The regulation, as filed with the OAL, and the February 2007 addendum to table A can be found on the DWC Web site at http://www.dir.ca.gov/dwc/DWCPropRegs/OMFS_tableA/OMFS_TableA.htm.

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