WorkersCompensation.com's CompNewsNetwork: CA DWC Responds To Payment Inquiries For Medical Treatment

CA DWC Responds To Payment Inquiries For Medical Treatment
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compnewsnetwork on 02 July, 2009 12:45:00
 
Sacramento, CA (CompNewsNetwork) - The Division of Workers’ Compensation (DWC)
has recently received inquiries regarding whether the Medicare payment rules
apply when paying for medical costs under the California official medical fee
schedule (OMFS).
Labor Code section 4600 provides that reasonably required medical treatment to
cure or relieve the effects of the injury, means treatment based upon the
medical treatment utilization schedule (MTUS) guidelines adopted by the
administrative director.
The MTUS, not Medicare coverage rules, apply to determine what treatment is
reasonably required.  If a question arises regarding whether a treatment is
medically reasonable and necessary, the claims administrator should use the
workers’ compensation utilization review procedures to determine the issue,
as required by Labor Code section 4610 and title 8, California Code of
Regulations section 9792.6 et seq.
Medical providers and payers should examine the various fee schedules in the
OMFS to determine which Medicare fee-related payment rules have been adopted.
For example, DWC has adopted the Medicare ambulance fee schedule fact sheet for
CY 2009.