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.

Give the gift of safety!

Our handy holiday gift guide has lots of ideas

By Erik Harden, Public Information Officer, BWC Communications Department

The holidays will be here before you know it! And if you’re like us, maybe you’re not quite done with your shopping. Well, we’ve got you covered with gift ideas to keep your adventurers, your do-it-yourselfers and your loved ones safe and healthy throughout the year.

This year, the experts in BWC’s Division of Safety & Hygiene who staff the Ohio Center for Occupational Safety & Health (OCOSH) have compiled this handy Safety & Health Gift Guide to help you give the gift that keeps on giving – safety and wellness.

The guide includes ideas for gifts to keep your friends and family safe at home and on the road. It also includes reminders about creating or reviewing plans in case of emergencies in the home.

Do you have weekend warriors at home? Check out the section dedicated to these handy folks for ideas ranging from proper footwear and hearing protection to task lighting and eye safety.

How about outdoor adventurers? From new harnesses and carabineers for rock climbers to gun safety classes for hunters, there are plenty of options to choose from.

The guide will also help you keep your kids safe with tips for buying the safest toys and products, from toddlers to teenagers.

Finally, it provides travel tips to keep you safe when travelling over the river and through the woods to grandmother’s house.

From all of us at BWC, we wish you a happy and SAFE holiday season and new year!

Cleveland painter guilty of workers’ comp fraud

reillo-photoA Cleveland-area man caught working while receiving injured workers’ benefits from BWC pleaded guilty Dec. 1 to a misdemeanor count of workers’ compensation fraud.

Angelo Reillo Sr., 32, of Garfield Heights, paid $3,354 in restitution to BWC at the time of his guilty plea in Franklin County Common Pleas Court. A judge fined him $50.

Acting on a tip, agents with BWC’s Special Investigations Department found Reillo working as a painter and supervisor from Oct. 20, 2014, until Dec. 3 that year while receiving living maintenance benefits from BWC. Living maintenance compensation is designed for workers who are actively participating in a BWC-approved vocational rehabilitation plan. The benefits are supposed to end after the injured worker returns to full-time work.

Agents determined Reillo engaged in “ongoing and regular substantially gainful remunerative employment, which was inconsistent with the receipt of LM benefits and contrary to entitlement.”

Coverage in other states: do you have it?

By Kendra DePaul, BWC Other States Coverage Managerkendra

With the New Year approaching, now is the time to begin planning for 2017. We encourage businesses to evaluate their current workers’ compensation coverage to ensure there are no potential coverage gaps.

Each state has different laws and requirements for workers’ compensation coverage. Consider each state where you send employees, and make sure proper coverage is in place.

We have many resources on our website to help employers work through requirements for work outside of Ohio. In addition, we work with a private insurer to offer optional coverage to employers with out-of-state exposures.

Through our Other States Coverage offering, employers can secure coverage nationwide in 46 states. From implementation in March 2016 through November 2016, more than 200 employers have secured coverage. These businesses have eliminated potential coverage gaps and compliance issues, which may arise when working out of state.

If your business is looking to expand outside Ohio, please contact BWC’s Other States Coverage unit to discuss your coverage options. We want you to have the proper coverage upfront, so that you can avoid any coverage issues and focus on having a successful 2017.

Contact the Other States Coverage unit at 614-728-0535 or via email bwcotherstatescoverage@bwc.state.oh.us.

A handy message for the flu season

By Sue Davis (“Safety Sue”), Director, BWC Employee Safety & Health Administration

hands-germs

In 1847, a Hungarian obstetrician by the name of Ignaz P. Semmelweiss showed that hand washing greatly reduced infections in newborns. Dr. Semmelweiss attempted to promote hand washing and cleanliness among his colleagues, who were so offended that they committed him to an insane asylum.

Today, it is a well-known fact that hand washing greatly reduces the spread of disease.

Yet studies show that only 67 percent of people practice any sort of hand hygiene. Researchers believe this number is low because most people have a vague idea that hand washing is important, but many don’t have a grasp on the facts.

Communicable diseases are serious business. At the very least, diseases – like a cold or the flu – impact your day-to-day life in a negative way. More serious diseases can be very dangerous to your health and to others.

Although the flu season lasts from October until May, the peak months are usually between December and March. In addition to the flu, varieties of other communicable diseases spread more easily in winter months.

As an employer, it’s important to do your part in preventing diseases from spreading in your workplace this flu season. In 2016, your employees won’t question your mental health for encouraging hand washing; in fact, December is National Hand Washing Month. So now is the time to remind your employees to wash their hands often, keep their workspaces clean and eat healthy. And if they are ill, encourage them to stay home.

Here are a few other facts to share with your employees:

  • Eighty percent of communicable diseases are transferred by touch.
  • Touch refers primarily to the touching of food, or the touching of one’s own mouth, eyes, and nose. It is not simply person-to-person contact.
  • Touching the face with contaminated hands spreads illnesses such as pneumonia, the common cold and the flu.
  • Hand washing can reduce the risk of respiratory infections by 16 percent.
  • More than 50 percent of healthy persons have Staphylococcus aureus (bacteria causing staph infections) living in or on their nasal passages, throats, hair or skin.
  • Less than 75 percent of women and less than 50 percent of men wash their hands after going to the bathroom.
  • The recommended washing time is 15 seconds. The ideal washing time is 30 seconds.
  • Only 20 percent of people dry their hands after washing. Damp hands are 1,000 times more likely to spread bacteria than dry hands.
  • Hand washing and hand hygiene initiatives greatly reduce the number of absences, sick leaves and lost productivity.

For more information:
http://www.cdc.gov/handwashing/
https://www.b4brands.com/blog/facts-hand-washing-hygiene/

Fraud conviction stains carpet cleaner’s record

A Florida man who had been collecting injured workers’ benefits from Ohio since 2011 pleaded guilty to workers’ compensation fraud Monday after investigators with the Ohio Bureau of Workers’ Compensation found him working as a carpet cleaner in Florida.

Jarrod B. Lewis, 40, of Palm Bay, Florida, must pay $5,300 in restitution to BWC and serve five years probation in lieu of a 12-month prison sentence for committing the fifth-degree felony, a Franklin County Common Pleas Court judge ruled Nov. 28.

Lewis, formerly of Chillicothe, Ohio, was working as a youth specialist for the Ohio Department of Youth Services when he was injured on the job in 2011. BWC’s Special Investigations Department started looking at Lewis in October 2013 after getting an anonymous tip that he was living and working in Florida. Agents determined Lewis returned to full-time work in April 2013 but intentionally withheld this information from BWC to receive benefits for which he was not entitled.

To report suspected workers’ compensation fraud, call 1-800-644-6292 or visit bwc.ohio.gov.