One Of OR's Proposed Rules Would Cut Surgery Fees Further

Proposes to exclude cervical artificial disc replacements from compensability

Portland, OR (CompNewsNetwork)- The Oregon Division of Workers’ Compensation is proposing changes which would update the medical fee schedules as required by ORS 656.248, and to make other changes consistent with the director’s responsibilities under ORS 656.726(4).

One of the proposed rules addresses:

Adoption of updated medical fee schedules and resources for the payment of health care providers; good cause exceptions for late billing; compensability of cervical artificial disc replacements; requirement for procedural codes on hospital bills; the basis for the director to exclude rural hospitals from imposition of the adjusted cost/charge ratio; billing procedures for ambulatory surgical centers; and payment of physician assistants or nurse practitioners who perform or assist in surgery.

Based on the advice of the Medical Advisory Committee, the director proposes to exclude cervical artificial disc replacements from compensability unless the devices and the patients meet specific conditions – with the goal to improve patient outcomes. Improved patient outcomes should lower overall medical costs paid by insurers. Restrictions affecting artificial disc replacement could have a slight negative fiscal impact on surgeons who perform disc replacements, though surgeons may perform other procedures on patients that do not meet the criteria for disc replacement. Because artificial disc replacement is not a commonly used procedure, the agency projects that the overall fiscal impact would be small.

Click the attachment to view the full extent of Oregon’s DWC’s proposed rules,.