Texas Workers' Compensation
Commissioner Betts Signs Medical Fee Guideline and Hospital Fee Guidelines Rules
Austin, TX (CompNewsNetwork) - Commissioner of Workers'
Compensation Albert Betts has signed rules to update a medical fee guideline for health
care providers, to establish a hospital outpatient fee guideline and to update a hospital
inpatient fee guideline for the Texas workers' compensation system (28 Texas
Administrative Code §§134.1, 134.2, 134.203, 134.204, 134.403 and 134.404). The medical fee
guideline rules relate to professional service reimbursements to health care providers who
provide medical treatments and services to injured employees on or after March 1, 2008. The
outpatient and inpatient hospital fee guidelines rules apply to inpatient admissions and
outpatient dates of service for injured employees on or after March 1, 2008.
In accordance with Labor Code § 413.011, the medical fee guideline and outpatient and
inpatient hospital fee guidelines use the Medicare system as a framework for billing and
reimbursement methods in the workers' compensation system. The guidelines establish
standardized formats for billing and reimbursement as used in group health and Medicare
systems. Also, in accordance with Labor Code §408.0052, the medical fee guideline
establishes new incentive payments to health care providers caring for injured employees in
areas of the state designated as underserved by Commissioner Betts.