Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › INTRODUCTION › Section 20-2-II - SCOPE

Current through June 25, 2024
The Mississippi Workers' Compensation Medical Fee Schedule
				  does the following:
A. Establishes
				rules/guidelines by which the employer shall furnish, or cause to be furnished,
				to an employee who suffers a bodily injury or occupational disease covered by
				the Mississippi Workers' Compensation Law, reasonable and necessary medical,
				surgical, and hospital services and medicines, supplies or other attendance or
				treatment as necessary. The employer shall provide to the injured employee such
				medical or dental surgery, crutches, artificial limbs, eyes, teeth, eyeglasses,
				hearing apparatus, and other appliances which are reasonable and necessary to
				treat, cure, and/or relieve the employee from the effects of the
				injury/illness, in accordance with MCA §
									71-3-15
				(Rev. 2000), as amended.
B.
				Establishes a schedule of maximum allowable reimbursement (MAR) for such
				treatment, attendance, service, device, apparatus, or medicine.
C. Establishes rules/guidelines by which a
				health care provider shall be paid the lesser of (a) the provider's total
				billed charge, or (b) the maximum allowable reimbursement (MAR) established
				under this Fee Schedule.
D.
				Establishes rules for cost containment to include utilization review of health
				care and health care services, and provides for the acquisition by an
				employer/payer, other interested parties, and the MWCC, of the necessary
				records, medical bills, and other information concerning any health care or
				health care service under review.
E. Establishes rules for the evaluation of
				the appropriateness of both the level and quality of health care and health
				care services provided to injured employees, based upon medically accepted
				standards.
F. Authorizes
				employers/payers to withhold payment from, or recover payment from, health
				facilities or health care providers that have made excessive charges or which
				have provided unjustified and/or unnecessary treatment, hospitalization, or
				visits.
G. Provides for the review
				by the employer/payer or MWCC of any health facility or health care provider
				records and/or medical bills that have been determined not to be in compliance
				with the schedule of charges established herein.
H. Establishes that a health care provider or
				facility may be required by the employer/payer to explain in writing the
				medical necessity of health care or health care service that is not usually
				associated with, is longer and/or more frequent than, the health care or health
				care service usually accompanying the diagnosis or condition for which the
				patient is being treated.
I.
				Provides for medical cost containment review and decision responsibility. The
				rules and definitions hereunder are not intended to supersede or modify the
				Workers' Compensation Act, the administrative rules of the MWCC, or court
				decisions interpreting the Act or the MWCC's administrative rules.
J. Provides for the monitoring of
				employers/payers to determine their compliance with the criteria and standards
				established by this Fee Schedule.
K.
				Establishes deposition/witness fees.
L. Establishes fees for medical
				reports.
M. Provides for uniformity
				in billing of provider services.
N.
				Establishes rules/guidelines for billing.
O. Establishes rules/guidelines for reporting
				medical claims for service.
P.
				Establishes rules/guidelines for obtaining medical services by out-of-state
				providers.
Q. Establishes
				rules/guidelines for Utilization Review to include pre-certification,
				concurrent review, discharge planning and retrospective review.
R. Establishes rules for dispute resolution
				which includes an appeal process for determining disputes which arise under
				this Fee Schedule.
S. Establishes a
				peer review system for determining medical necessity. Peer review is conducted
				by professional practitioners of the same specialty as the treating medical
				provider on a particular case.
T.
				Establishes the list of health care professionals who are considered authorized
				providers to treat employees under the Mississippi Workers' Compensation Law;
				and who, by reference in this rule, will be subject to the rules, guidelines
				and maximum allowable reimbursement (MAR) in this Fee Schedule.
U. Establishes financial and other
				administrative penalties to be levied against payers or providers who fail to
				comply with the provisions of the Fee Schedule, including but not limited to
				interest charges for late billing or payment, percentage penalties for late
				billing or payment, and additional civil penalties for practices deemed
				unreasonable by the MWCC.