Bulletin No. 07-03
March 23, 2003

Public discussion forums on proposed OMFS revisions and new standardized/electronic billing regulations posted to the DWC web site

Two new public discussion forums have been posted to the DWC web site. One contains draft proposed rules for revision of the Workers' Compensation Official Medical Fee Schedule (OMFS). The other is a draft proposal that would adopt standardized billing forms and require that providers accept electronic billing. Links to the forums and rules for participating can be found at http://www.dir.ca.gov/wcjudicial.htm.

The general approach of the proposed OMFS revisions is to migrate from the current largely charge-based system to a fee schedule that utilizes the 2003 Resource Based Relative Value Scale adopted by the Center for Medicare and Medicaid Services. The draft proposal suggests utilizing some of the Medicare payment policies and rules, and it also suggests additional compensation for the Evaluation and Management Codes to reflect additional work and expense involved in workers' compensation. Many aspects of the proposal are based on the work of the Lewin Group that performed three studies for the Industrial Medical Council.

The forum on standardized and electronic billing includes draft proposed regulations that are intended to implement Labor Code Section 4603.4 that was adopted as part of AB 749, the omnibus workers' compensation reform bill passed in 2002. The regulations are intended to adopt standardized billing forms and mandate that claims administrators accept electronic billings by providers.

The DWC/WCAB Forums are a unique way for the public to review and comment on draft proposed regulations and revisions before formal rulemaking begins. Visitors to the site can also view the comments made by others. All comments are reviewed and considered before the final proposed new regulations or revisions to regulations are scheduled for public hearing.

Members of the public are encouraged to participate