Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › DISPUTE RESOLUTION RULES › Section 20-2-V - MWCC REVIEW OF A DISPUTE

Current through June 25, 2024
A. Any party
				aggrieved by the decision of the Cost Containment Division shall have twenty
				(20) days from the date of said decision to request review by the MWCC. Unless
				permitted to appear pro se, all parties participating in MWCC review of a
				decision of the Cost Containment Division are required to be represented by an
				attorney licensed in Mississippi.
Failure to file a written request for review with the MWCC
				  within this twenty (20) day period shall bar any further review or action with
				  regard to the issue(s) presented. A decision of the Cost Containment Division
				  that is not timely appealed shall constitute a final decision of the Full MWCC,
				  with all findings and determinations of the Cost Containment Director,
				  including the award of penalties, interest, and attorney's fees and/or
				  expenses, to be considered as having been awarded by the Full MWCC itself,
				  including any penalty under Mississippi Code Annotated Section
				  71-3-59.
				  No extension of time within which to file for MWCC review of a dispute under
				  these Rules shall be allowed. In the event a request for review is not filed
				  with the MWCC within twenty (20) days, the parties to the dispute shall have
				  fourteen (14) days thereafter in which to comply with the final decision of the
				  Cost Containment Division.
A party to a dispute may, when a written request for review
				  has not been timely filed with the MWCC, seek enforcement of payment of that
				  decision pursuant to the terms and time period set forth in Mississippi Code
				  Annotated Section
				  71-3-49.
				  A Final Decision of the Cost Containment Division and/or the MWCC shall be
				  considered sufficient to allow the payer and/or provider to pursue any and all
				  remedies available to it for enforcement of payment in default pursuant to
				  Mississippi Code Annotated Section
				  71-3-49.
				  No further action to enforce payment shall be made by the MWCC, nor shall any
				  other document be issued regarding the dispute unless the MWCC finds the
				  issuance of such document to be necessary. The payer and/or provider shall be
				  solely responsible for calculating the interest and penalty owed to it pursuant
				  to the terms of the Fee Schedule, and any dispute regarding enforcement of
				  payment in default and/or the amount of interest or penalty due shall be
				  determined by the Court wherein the payer or provider has sought enforcement
				  pursuant to Mississippi Code Annotated. Section
				  71-3-49.
				  The same procedure for enforcement above shall also be applicable to all final
				  decisions of the MWCC in the event the decision of the Cost Containment
				  Division was timely appealed to the MWCC and a final decision of the MWCC has
				  been issued.
B. The request
				for review by the MWCC shall be filed with the Cost Containment Division of the
				Mississippi Workers' Compensation Commission, shall be in writing, and shall
				state the grounds on which the requesting party relies. All documentation
				submitted to and considered by the Cost Containment Division, including the
				Request for Resolution of Dispute form, along with a copy of the decision of
				the Cost Containment Division, shall be attached to the request for review
				which is filed with the MWCC. The party seeking relief hereunder shall certify
				that a copy of the request for review and any supporting documentation being
				filed with the MWCC has been provided to the other interested parties or their
				representatives by certified mail simultaneously with the filing to the MWCC.
				Unlike the Request for Resolution of Dispute Form, there is no specific
				prescribed form for a Request for MWCC Review.
C. The MWCC shall review the issue(s) solely
				on the basis of the documentation submitted to the Cost Containment Division.
				No additional documentation not presented to and considered by the Cost
				Containment Division shall be considered by the MWCC on review, unless
				specifically requested by the MWCC, and no hearing or oral argument shall be
				allowed, unless specifically requested by the MWCC.
D. The MWCC shall consider the request for
				review and issue a decision.
E.
				Following the decision of the MWCC, or following the conclusion of the dispute
				resolution process at any stage without an appeal to the MWCC, no further
				audit, adjustment, refund, review, consideration, reconsideration or appeal
				with respect to the claim in question by the MWCC may be sought by either
				party.
F. The costs incurred in
				seeking MWCC review, or in seeking compliance with an Administrative Decision
				rendered by the Cost Containment Director, including reasonable attorney fees,
				if any, may be assessed to the party who requested review if that party's
				position is not sustained by the MWCC and to the party who has failed to comply
				with a prior decision if compliance therewith is ordered by the MWCC.
				Otherwise, each party shall bear their own costs, including attorney's fees.
G. If the Cost Containment
				Director and/or the MWCC determines that a dispute is based on or arises from a
				billing error, a payment adjustment or error, including but not limited to
				improper bundling of service codes, unbundling, downcoding, code shifting, or
				other action by either party to the dispute, or if the MWCC determines that a
				provider or payer has unreasonably refused to comply with the Law, the Rules of
				the MWCC, including this Fee Schedule, or with any decision of the MWCC or its
				representatives, and that this causes proceedings with respect to the billing
				and/or payment for covered medical services to be instituted or continued or
				delayed without reasonable grounds, then the MWCC may require the responsible
				party or parties, and/or the attorney advising such party or parties, to pay
				the reasonable expenses, including attorney's fees, if any, to the opposing
				party; and, in addition, the MWCC may levy against the responsible party or
				parties a civil penalty not to exceed the sum of ten thousand dollars
				($10,000.00), payable to the MWCC, as provided in §
									71-3-59(2)
				of the Law. The award of costs and penalties as herein provided shall be in
				addition to interest and penalty charges which may apply under other provisions
				of this Fee Schedule.
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