Newsline No. 12-10 printer image Printer friendly

March 15, 2010

 

Division of Workers' Compensation reminds facilities seeking to be paid for high cost outlier
cases to submit by March 31, 2010 and posts adjustments to outpatient hospital and
ambulatory surgical center services section of the official medical fee schedule

The Division of Workers’ Compensation (DWC) is reminding facilities that are seeking to be paid for high cost outlier cases to submit their written election by March 31, 2010. Facilities seeking to be paid for high cost outlier cases under Title 8 California Code of Regulations section 9789.33(b) must file a written election using DWC Form 15 “Election for High Cost Outlier,” contained in section 9789.37 with the DWC Medical Unit, (Attention: OMFS-Outpatient). The form must be post-marked by March 31, 2010, and shall be effective for one year commencing with services furnished on or after April 1, 2010. The DWC will post a list of hospital outpatient departments and ambulatory surgery centers that have opted for the alternate high cost outlier payment methodology by April 15, 2010. These facilities, rather than being paid at 1.22 times the Medicare rate on all cases, are paid at 1.20 times the Medicare rate on all cases plus an additional payment for specific outlier cases. Only these facilities are entitled to be paid using the alternate method under section 9789.33 (b).

Additionally, the DWC has posted adjustments to the outpatient hospital departments and ambulatory surgical centers section of the official medical fee schedule (OMFS) to conform to changes in the Medicare payment system as required by Labor Code section 5307.1. The changes take effect April 15, 2010. 

Further information and the adjustments to the outpatient hospital departments and ambulatory surgical centers section of the OMFS can be found at: http://www.dir.ca.gov/DWC/OMFS9904.htm.

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