Five things you need to know about BWC’s provider fee schedules

By Yvette Christopher, Technical Medical Manager, Medical Policy

The Ohio Bureau of Workers’ Compensation (BWC) relies on a network of medical professionals to care for Ohioans injured on the job so they can return to work as quickly as possible. Competitive fees are essential to maintaining an excellent network of providers to deliver hands-on, quality care.

A fee schedule lists the maximum cost for which BWC will pay for services rendered. A fee schedule should provide a reasonable reimbursement for services rendered, while still maintaining a forum for the provision of cost effective, medically necessary services.

The Reimbursement and Coding Department within BWC’s Medical Services’ Division is responsible for development of fee schedules. The department partners with our providers and provider associations to develop appropriate methodologies to reimburse for services provided to Ohio’s injured workers.

Here are five things you need to know about BWC’s provider fee schedules:

  1. BWC has five fee schedules: The Professional Provider Fee Schedule, Outpatient Hospital, Inpatient Hospital Fee Schedule, Ambulatory Surgical Center Fee Schedule and the Vocational Rehabilitation Provider Fee Schedule.
  2. The fee schedules are implemented and changes are applied through the Ohio Administrative Code rule-making process annually. Rules applicable to the BWC fee schedules can be found on the BWC Web at www.bwc.ohio.gov.
  3. The fee schedules are modeled using the Centers for Medicare and Medicaid as a basis. BWC inflates the Medicare fee schedule by a set percentage often referred to as a Payment Adjustment Factor (PAF). The professional provider fee schedule PAF is between 125% and 220% of Medicare, depending on the procedure code.  The Ambulatory Surgical Center PAF is between 100-112%, depending on the procedure code. For February 2017, the inpatient PAF will be 112.7% for MS-DRG and DGME and 175.4% for outliers. Also proposed for May 2017, the outpatient PAF for children’s hospitals will be 266.9% and for non-children’s hospitals, 152.9%.
  4. BWC accepts stakeholder comments related to the annual implementation of the fee schedule. The proposed annual updates are published on the BWC web and comments are accepted for two weeks. The typical timeframe is approximately five months prior to the annual effective date of the rule. Stakeholders can request to be on the notification mailing list by contacting BWC at feedback.medical@bwc.state.oh.us.
  5. Each fee schedule has an annual rule effective date. The professional provider fee schedule is effective January 1 of each year. The outpatient hospital fee schedule and inpatient hospital fee schedules are effective May 1 and February 1, respectively. The ambulatory surgical center fee schedule is effective May 1. The vocational rehabilitation fee schedule is reviewed, but may not be updated annually.

Our network of medical professionals serves as the foundation for Ohio’s workers’ comp system. We’ll continue to regularly review our fee schedules so that Ohio’s injured workers have access to a variety of excellent providers who can put them on the road to recovery and a return to work.

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