November 20, 2018
by Kevin Anderson

WCD Rulemaking Meeting – Medical Billing/Services

The WCD held another public advisory meeting, this time to discuss the medical billing and medical services administrative rules.

Probably the most important and interesting topic was whether the WCD should look into rules to regulate and/or promote telemedicine in Oregon. The discussion was generally positive. Allowing workers to speak with a doctor via video on the work site was described as a good screening tool to determine whether the worker needed to seek emergency, urgent, or any follow up care. Telemedicine would also increase the availability of medical providers to many workers in rural areas. If you have any experience with telemedicine and workers’ compensation claims, the WCD would like your input.

Our meeting agenda also covered a variety of other issues including:

  • Whether the WCD could change/eliminate the requirement of submitting an indexed packet for certain MRT disputes. We supported the change as it lowers the time and cost involved in responding to these disputes.
  • Whether providers can charge workers for a no-show appointment. There was concern whether the WCD had jurisdiction to address this and its effect on providing appropriate medical care to the worker.
  • Whether to clarify the rules for approving an out-of-state physician compared to withdrawing approval for an out-of-state physician. We supported a streamlined approach to this issue.
  • Whether the WCD should create a rule requiring a 14-day response to pre-authorize physical therapy. We opposed the creation of another deadline and explained there are already rules in place outlining the approval of ancillary medical treatment.
  • Whether the WCD should remove the rule stating a chart note can sometimes be sufficient to trigger a surgery request. We recommended the creation of a form for the doctors to submit to initiate a surgery request to clarify the process.

The rest of the meeting was spent addressing billing codes, fee schedules, and a discussion about how to best compare Oregon workers compensation rates to other markets (i.e. whether to use the All-Payer-All-Claims database).

The WCD will take our discussion into consider before deciding whether to draft rules or move forward with any changes. If you have any feedback, questions, or comments on these topics or any medical billing/services rules, please contact me directly at (503)595-2130 or by ">email.