Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › INPATIENT HOSPITAL AND OUTPATIENT FACILITY PAYMENT SCHEDULE AND RULES › Section 20-2-I - INPATIENT AND OUTPATIENT CARE RULES

Current through June 25, 2024
A.
Definition.
For purposes of this schedule, a patient is considered
				an "inpatient" if formally admitted as an inpatient with the expectation that
				he or she will require hospital care that is expected to span at least two (2)
				midnights.
B.  Health care
				facilities providing services to workers' compensation claimants must meet
				requirements of the state of Mississippi.
C.
Billing and Reimbursement Rules for
				Inpatient Care.
1. Facilities must
				submit the bill for inpatient services within thirty (30) days after discharge.
				For those cases involving extended hospitalization, interim bills must be
				submitted every thirty (30) days.
2. Reimbursement for acute inpatient hospital
				services shall be the lesser of the amount billed or the MAR for the
				diagnosis-related group (DRG) as fixed by the rules set forth in this section
				of the Fee Schedule.
3. Non-covered
				charges include but are not necessarily limited to:
a. Convenience items;
b. Charges for services not related to the
				work injury/illness; and
c.
				Services that were not certified by the payer or their representative as
				medically necessary.
4.
				When reviewing surgical claims, including for outlier consideration, the
				following apply:
a. Most operative procedures
				require cardiopulmonary monitoring either by the physician performing the
				procedure or an anesthesiologist/anesthetist. Because these services are
				integral to the operating room environment, they are considered as part of the
				OR fee and are not separately reimbursed, nor are they included separately in
				the total charge for outlier consideration:
* Cardiac monitors;
* Oximetry;
* Blood pressure monitor;
* Lasers;
* Microscopes;
* Video equipment;
* Set up fees;
* Additional OR staff;
* Gowns;
* Gloves;
* Drapes;
* Towels;
* Mayo stand covers;
* On-call or call-back fees; and
* After-hours fees.
b. Billing for surgery packs as well as
				individual items in the packs is not allowed and shall not be included in the
				total charge for outlier consideration.
c. A majority of invasive procedures requires
				availability of vascular and/or airway access; therefore, the work associated
				with obtaining this access is included in the cost of the service, i.e.,
				anesthesia-airway access is associated with general anesthesia and is included
				in the anesthesia charges.
d.
				Recovery room and ICU rates include the charge for cardiac monitoring and
				oximeter. It is assumed the patient is placed in these special areas for
				monitoring and specialized care which is bundled into the special care rate.
				Call-back fees are not reimbursed for recovery room.
e. Separate reimbursement is not allowed for
				setting up portable equipment at the patient's bedside.
f. The following items do not qualify for
				separate reimbursement regardless of inpatient or outpatient status, and are
				not included in the total charge for outlier consideration:
* Applicators, cotton balls, band-aides;
* Syringes;
* Aspirin;
* Thermometers, blood pressure apparatus;
* Water pitchers;
* Alcohol preps; and
* Ice bags.
g. Separate reimbursement is not allowed for
				equipment such as compressive devices, or other equipment used during the
				operative or immediate postoperative period.
5. Maximum reimbursement is set for the
				following line item charges.
a. IV pump/daily
				- $50.00
b. Venipuncture
				reimbursement is limited to $4.25 per collection. A collection fee is not
				appropriate for finger stick, throat culture, or stool specimen collection
c. Pharmacy add-mixture/dispensing
				fee is limited to $4.50 per mixture