reglab/statecodes huggingface dataset:
Mississippi Administrative Code › Title 20 - Labor › Part 1 - Rules of the Mississippi Workers' Compensation Commission › Chapter 2 - Procedural Rules › Rule 20-1-2.20 - Filing of Pleadings and Other Documents

Current through June 25, 2024
A. Attorneys of
				Record
Any document or pleading prepared by an attorney representing
				  a party shall be electronically filed with the Commission through ATOS and
				  contain the typed or printed name, official Mississippi Bar identification
				  number, email address, mailing address and telephone number of the attorney.
				  Once a claim is controverted, each party shall certify that he or she has sent
				  a copy of the pleading or other document to each other party to the claim. Any
				  document or pleading requiring a claimant's signature may be electronically
				  signed using DocuSign.
All pleadings and other documents filed with the Commission,
				  including any stenographically reported depositions, shall be typed or printed
				  on letter size (8-1/2 x 11) paper to conform with the Mississippi Rules of
				  Civil Procedure and the Mississippi Rules of Appellate Procedure and shall
				  contain the style of the claim and Commission file number.
Any proposed order submitted to the Commission or
				  Administrative Judge shall be signed by the party preparing the order, and
				  where the proposed order is an agreed or joint order, such as an order
				  approving settlement, it must be signed and approved by an attorney or other
				  legal representative for each party.
B. Unrepresented Party
An unrepresented party shall file all pleadings and documents
				  required by the Commission by mail addressed to the attention of the
				  Administrative Judge assigned to the claim.
Miss. Code
				  Ann. §
										71-3-85.
Mississippi Administrative Code › Title 20 - Labor › Part 1 - Rules of the Mississippi Workers' Compensation Commission › Chapter 2 - Procedural Rules › Rule 20-1-2.21 - Address and Phone of Parties

Current through June 25, 2024
Every party to a controverted or non-controverted case must
				  keep the Commission informed of that party's current address, e-mail address
				  and telephone number. Attorneys representing a party in any claim shall also
				  keep the Commission informed of their current address, telephone number,
				  facsimile number, and e-mail address.
All self-insured employers, workers' compensation insurance
				  carriers, and third party administrators shall also maintain a single address,
				  e-mail address and telephone number on file with the Commission for the purpose
				  of electronic service, notice, and/or other correspondence with the Commission.
Claimants, either self-represented or through their
				  attorney, must provide the Commission with their current mailing address,
				  e-mail address and telephone number.
All of the above have a continuing obligation during the
				  claim to notify the Commission of any changes in their required contact
				  information. The most recent contact information on file with the Commission
				  shall be presumed correct unless the Commission is notified otherwise in
				  writing.
Miss. Code Ann. §
										71-3-85.
Mississippi Administrative Code › Title 20 - Labor › Part 1 - Rules of the Mississippi Workers' Compensation Commission › Chapter 2 - Procedural Rules › Rule 20-1-2.22 - Prehearing Motions; Motion Days

Current through June 25, 2024
(a) All motions
				shall be filed in the manner prescribed by Miss. Work. Comp. Comm. Rule
				2.20. All documents to be considered
				as evidence by the Administrative Judge shall be attached to the motion or
				described with specificity if already filed. A proposed order must accompany
				each nondispositive motion. The movant shall serve a copy of the motion,
				attachments and proposed order on the opposite party.
(b) A party desiring oral argument on a
				motion shall:
1. notice the motion for motion
				day or other agreed time and place permitted by the Administrative
				Judge;
2. coordinate the date and
				time of the hearing with the opposing party and the Administrative
				Judge;
3. if the nonmoving party
				does not confirm a motion hearing date with the Administrative Judge's legal
				assistant within two (2) business days after dates are provided, movant may
				unilaterally select an open hearing date and notice the motion for hearing on
				that date;
4. allow at least five
				(5) calendar days before setting the motion hearing, unless the parties and
				Administrative Judge agree otherwise;
5. file the notice of hearing with the
				Commission; and
6. serve a copy of
				the notice of hearing on the opposing party.
Mississippi Administrative Code › Title 20 - Labor › Part 1 - Rules of the Mississippi Workers' Compensation Commission › Chapter 2 - Procedural Rules › Rule 20-1-2.23 - Earwigging Prohibited

Current through June 25, 2024
No person or party shall discuss or attempt to discuss with
				  or in the presence of a Commissioner or Administrative Judge the merits of a
				  claim which is pending before the Commission or Administrative Judge or which
				  is likely to be pending therein, except in pleadings, motions, briefs, forms or
				  other correspondence necessarily required in the development and presentation
				  of a claim to the Commission or Administrative Judge. No person or party shall
				  attempt in any manner, except as stated above, to influence the decision of a
				  Commissioner or Administrative Judge in any such matter. No person or party
				  shall send any written communication to a Commissioner or Administrative Judge
				  on any matter pending or likely to be pending before the Commission or
				  Administrative Judge without simultaneously delivering or mailing a copy of
				  that communication to all other parties to the claim, or their legal
				  representatives.
Any person or party who violates the provisions of this Rule
				  shall be subject to sanctions as determined by the Commission or Administrative
				  Judge.
Miss. Code Ann. §
										71-3-85.
Mississippi Administrative Code › Title 20 - Labor › Part 1 - Rules of the Mississippi Workers' Compensation Commission › Chapter 2 - Procedural Rules › Rule 20-1-2.24 - Requests for Declaratory Opinions

Current through June 25, 2024
Scope of Rules
100 These sections set forth the Commission's
				Rules governing the form and content of requests for declaratory opinions and
				the Commission's procedures regarding the requests as required by Mississippi
				Code 25-43-2.103.
Persons Who May Request Declaratory
				  Opinions
101.01 Any person with
				a substantial interest in the subject matter may make a request to the
				Commission for a declaratory opinion by following the specified procedures.
101.02 "Substantial interest in
				the subject matter" as used in this chapter means: that a party is directly
				affected by the Commission's administration of the laws within the Commission's
				primary jurisdiction.
101.03
				"Primary jurisdiction of the Agency" as used in this chapter means the
				Commission has a constitutional or statutory grant of authority in the subject
				matter at issue.
101.04 (Reserved)
Subjects Which May Be Addressed In Declaratory
				  Opinions
201 The Commission will
				issue declaratory opinions regarding the applicability to specified facts of:
1. a statute administered or enforceable by
				the Commission,
2. a rule
				promulgated by the Commission, or
3. an order issued by the Commission.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › INTRODUCTION › Section 20-2-I - FORMAT

Current through June 25, 2024
This Fee Schedule is comprised of the following sections:
				  Introduction; General Rules; Billing and Reimbursement Rules; Medical Records
				  Rules; Dispute Resolution Rules; Pre-certification and Authorization Review
				  Rules; Modifiers and Code Rules; Pharmacy Rules; Other Qualified Health Care
				  Professional Rules; Home Health Rules; Evaluation and Management; Anesthesia;
				  Pain Management; Surgery; Radiology; Pathology and Laboratory; Medicine
				  Services; Therapeutic Services; Dental; Inpatient Hospital and Outpatient
				  Facility Payment Schedule and Rules; and HCPCS. Each section listed above has
				  specific instructions (rules/guidelines). The Fee Schedule is divided into
				  these sections for structural purposes only. Providers are to use the specific
				  section(s) that contains the procedure(s) they perform or the service(s) they
				  render. In the event a rule/guideline contained in one of the specific service
				  sections conflicts with a general rule/guideline, the specific section
				  rule/guideline will supersede, unless otherwise provided elsewhere in this Fee
				  Schedule.
This Fee Schedule utilizes procedure codes under copyright
				  agreement. The descriptions included are medium procedure descriptions. A
				  complete list of modifiers is provided in the Modifier and Code Rules
				  section.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › INTRODUCTION › Section 20-2-VI - AUTHORIZED PROVIDERS

Current through June 25, 2024
The following health care providers are recognized by the
				  MWCC as acceptable to provide treatment to injured workers under the terms of
				  the Act, and must comply with the rules, guidelines, billing and reimbursement
				  policies, and maximum allowable reimbursement (MAR) contained in this Fee
				  Schedule when providing treatment or service under the terms of the Act:
Acupuncturist (L.A.C.)
Audiologist
Certified Registered Nurse Anesthetist (C.R.N.A.)
Doctor of Chiropractic (D.C.)
Doctor of Dental Surgery (D.D.S.)/Doctor of Dental Medicine
				  (D.D.M.)
Doctor of Osteopathy (D.O.)
Licensed Clinical Social Worker (L.C.S.W.)
Licensed Nursing Assistant
Licensed Practical Nurse (L.P.N.)
Massage Therapist
Medical Doctor (M.D.)
Nurse Practitioner (N.P.)
Occupational Therapist (O.T.)
Optometrist (O.D.)
Oral Surgeon (M.D., D.O., D.M.D., D.D.S.)
Pharmacist (R.Ph, PharmD.)
Physical Therapist (P.T.)
Physical or Occupational Therapist Assistant (P.T.A., O.T.A.)
Physician Assistant (P.A.)
Podiatrist (D.P.M.)
Prosthetist or Orthotist Psychologist (Ph.D.)
Registered Nurse (R.N.)
Registered Nurse First Assistant (R.N.F.A., R.A.)
Speech Therapist
All health care providers, as listed herein, are subject to
				  the rules, limitations, exclusions, and maximum allowable reimbursement of this
				  Fee Schedule. Medical treatment under the terms of the Act may be provided by
				  any other person licensed, registered, or certified as a health care
				  professional if approved by the payer or MWCC, and in such case, said provider
				  and payer shall be subject to the rules and guidelines, including maximum
				  allowable reimbursement amounts, provided herein.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › INTRODUCTION › Section 20-2-VII - INFORMATION PROGRAM

Current through June 25, 2024
The MWCC shall provide ongoing information regarding this Fee
				  Schedule for providers, payers, their representatives and any other interested
				  persons or parties. This information shall be provided primarily through
				  informational sessions and seminar presentations at the Mississippi Workers'
				  Compensation Educational Association Conference as well as the distribution of
				  appropriate information materials via the MWCC's website (www.mwcc.ms.gov [File
				  Link Not Available]), and by other means as needed. Updates to this Fee
				  Schedule will also be posted to the FAIR Health website at
				  https://orders.fairhealth.org [File Link Not Available].
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › GENERAL RULES › Section 20-2-I - Confirmatory Consultation

Current through June 25, 2024
As provided in §
									71-3-15(1)
				  of the Act, and in MWCC General Rule 9, a payer/employer may request a second
				  opinion examination or evaluation for the purpose of evaluating temporary or
				  permanent disability or medical treatment being rendered. This examination is
				  considered a confirmatory consultation. The confirmatory consultation is billed
				  using the appropriate level and site-specific consultation code with modifier
				  32 appended to indicate a mandated service and paid in accordance with the Fee
				  Schedule.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › GENERAL RULES › Section 20-2-I - CONFIRMATORY CONSULTATION

Current through June 25, 2024
As provided in §
									71-3-15(1)
				  of the Act, and in MWCC General Rule 1.9, a payer/employer may request a second
				  opinion examination or evaluation for the purpose of evaluating temporary or
				  permanent disability or medical treatment being rendered. This examination is
				  considered a confirmatory consultation. The confirmatory consultation is billed
				  using the appropriate level and site-specific consultation code with modifier
				  32 appended to indicate a mandated service and paid in accordance with the Fee
				  Schedule.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › GENERAL RULES › Section 20-2-II - CODING STANDARD

Current through June 25, 2024
A. The most current
				version of the American Medical Association's Current Procedural Terminology
				(CPT®) or the most current version of the American Dental Association's
				CDT: Dental Procedure Codes in effect at the time service is rendered or
				provided shall be the authoritative coding guide, unless otherwise specified in
				this Fee Schedule.
B. The most
				current version of HCPCS codes developed by CMS in effect at the time service
				is rendered or provided shall be the authoritative coding guide for durable
				medical equipment, prosthetics, orthotics, and other medical supplies (DMEPOS),
				unless otherwise specified in this Fee Schedule.
C. Bills for services will be subject to
				appropriate code edits. For the purpose of this Fee Schedule, the National
				Correct Coding Initiative (NCCI) edits are used, and apply to all sections
				unless an exception is addressed in a particular section.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › GENERAL RULES › Section 20-2-IV - IMPAIRMENT RATING

Current through June 25, 2024
A. In determining
				the extent of permanent impairment attributable to a compensable injury, the
				provider shall base this determination on the most current edition of the
				Guides to the Evaluation of Permanent Impairment, as published and copyrighted
				by the American Medical Association which is in effect at the time the service
				is rendered. Only a medical doctor is entitled under these rules to
				reimbursement for conducting an impairment rating evaluation.
B. A provider is entitled to reimbursement
				for conducting an impairment rating evaluation and determining the extent of
				permanent impairment, and should bill for such services using CPT code 99455.
				The maximum allowable reimbursement for CPT code 99455 shall be
				$250.00.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › GENERAL RULES › Section 20-2-V - INDEPENDENT MEDICAL EXAMINATION (IME)

Current through June 25, 2024
A. An independent
				medical examination (IME) may be ordered by the MWCC or its Administrative
				Judges. A practitioner other than the treating practitioner must do the medical
				examination, and the MWCC or Judge shall designate the examiner.
B. An independent medical examination (IME)
				shall include a study of previous history and medical care information,
				diagnostic studies, diagnostic x-rays, and laboratory studies, as well as an
				examination and evaluation. An IME can only be ordered by the MWCC or one of
				its Administrative Judges. A copy of the report must be sent to the patient, or
				his attorney if represented, the payer, and the MWCC.
C. The fee for the IME may be set by the MWCC
				or Judge, or negotiated by the payer and provider prior to setting the
				appointment, and in such cases, reimbursement shall be made according to the
				order of the MWCC or Judge, or according to the mutual agreement of the
				parties. In the absence of an agreement or order regarding reimbursement for an
				IME, the provider shall bill for the IME using the appropriate level and
				site-specific consultation code appended with modifier 32 to indicate a
				mandated service, and shall be reimbursed according to the Fee
				Schedule.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › GENERAL RULES › Section 20-2-VI - EMPLOYER'S MEDICAL EXAMINATION (EME)

Current through June 25, 2024
A. An examination
				of the claimant by a physician of the employer's/carrier's choosing. If the
				claimant refuses these services, the claimant's benefits may be suspended. The
				employer/carrier may not unilaterally suspend benefits based upon the
				claimant's failure to attend an EME. The statute authorizes only the MWCC to
				suspend benefits for failure to comply with medical treatment.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › GENERAL RULES › Section 20-2-VII - MAXIMUM MEDICAL IMPROVEMENT

Current through June 25, 2024
A. When an employee
				has reached maximum medical improvement (MMI) for the work related injury
				and/or illness, the physician should promptly, and at least within fourteen
				(14) calendar days, submit a report to the payer showing the date of maximum
				medical improvement (MWCC Form B9,27).
B. Maximum medical improvement is reached at
				such time as the patient reaches the maximum benefit from medical treatment or
				is as far restored as the permanent character of his injuries will permit
				and/or the current limits of medical science will permit. Maximum medical
				improvement may be found even though the employee will require further
				treatment or care. The CMS-1500 form will be accepted in lieu of the Commission
				form if appropriate office/progress notes are attached.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › GENERAL RULES › Section 20-2-VIII - OUT-OF-STATE MEDICAL TREATMENT

Current through June 25, 2024
A. Each employer
				shall furnish all reasonable and necessary drugs, supplies, hospital care and
				services, and medical and surgical treatment for the work-related injury or
				illness. All such care, services, and treatment shall be performed at
				facilities within the state when available.
B. When billing for out-of-state services,
				supporting documentation is necessary to show that the service being provided
				cannot be performed within the state, the same quality of care cannot be
				provided within the state, or more cost-effective care can be provided
				out-of-state. In determining whether out-of-state treatment is more cost
				effective, this question must be viewed from both the payer and patient's
				perspective. Treatment should be provided in an area reasonably convenient to
				the place of the injury or the residence of the injured employee, in addition
				to being reasonably suited to the nature of the injury.
C. Reimbursement for out-of-state services
				shall be based on one of the following, in order of preference:
(1) the workers' compensation fee schedule
				for the state in which services are rendered; or
(2) in cases where there is no applicable fee
				schedule for the state in which services are rendered, or the fee schedule in
				said state excludes or otherwise does not provide reimbursement allowances for
				the services rendered, reimbursement should be paid at the usual and customary
				rate for the geographical area in which the services are rendered; or
(3) reimbursement for out-of-state services
				may be based on the mutual agreement of the parties. The Mississippi Workers'
				Compensation Medical Fee Schedule coding and billing rules apply whenever an
				injured employee is receiving workers' compensation benefits under Mississippi
				law or would be entitled to receive benefits under Mississippi law, whether the
				treatment is in Mississippi or any other state in order for out-of-state
				providers to obtain reimbursement.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › GENERAL RULES › Section 20-2-IX - RETURN TO WORK

Current through June 25, 2024
If an employee is capable of some form of gainful employment,
				  it is advisable for the physician to release the employee to light work and
				  make a specific report to the payer as to the date of such release and setting
				  out any restrictions on such light work. It can be to the employee's economic
				  advantage to be released to light or alternative work, since he/she can receive
				  compensation based on sixty-six and two-thirds percent (66 2/3%) of the
				  difference between the employee's earnings in such work and the employee's
				  pre-injury average weekly wage. The physician's judgment in such matters is
				  extremely important, particularly as to whether the patient is medically
				  capable of returning to work in some capacity. Return to work decisions should
				  be based on objective findings, and the physician's return to work assessment
				  should identify, if possible, any alternative duty employment to which the
				  patient may return if return to full duty is not medically
				  advisable.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › GENERAL RULES › Section 20-2-X - SELECTION OF PROVIDERS

Current through June 25, 2024
The selection of appropriate providers for diagnostic testing
				  or analysis, including but not limited to surgical/procedure facilities, CT or
				  MRI scans, x-ray, laboratory, physical or occupational therapy, including work
				  hardening, functional capacity evaluations, chronic pain programs, or massage
				  therapy shall be at the direction of the treating or prescribing physician. In
				  the absence of specific direction from the treating or prescribing physician,
				  the selection shall be made by the payer, in consultation with the treating or
				  prescribing physician.
Referral for an electromyogram (EMG) or a nerve conduction
				  study (NCS) shall be at the discretion and direction of the physician in charge
				  of care, and neither the payer nor the payer's agent may unilaterally or
				  arbitrarily redirect the patient to another provider for these tests. The payer
				  or the payer's agent may, however, discuss with the physician in charge of care
				  appropriate providers for the conduct of these tests in an effort to reach an
				  agreement with the physician in charge as to who will conduct an electromyogram
				  and/or nerve conduction study in any given case.
The selection of providers for the purchase or rental of
				  durable medical equipment shall be at the direction of the payer if over
				  $300.00.
The selection of providers for medical treatment or service,
				  other than as above provided, shall be in accordance with the provisions of MCA
				  §
									71-3-15.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › GENERAL RULES › Section 20-2-XII - DRUG SCREENING (MCA Section 71-3-121)

Current through June 25, 2024
Only one (1) drug screen or drug test result shall be
				  eligible for reimbursement for each drug test conducted on the same patient on
				  the same day, unless the initial screening results are deemed by the
				  prescribing provider to be inconsistent or inherently unreliable. In that
				  event, a confirmation screening may be ordered by the prescribing provider and
				  paid for by the payer. In addition, treatment may not be discontinued based on
				  the results of a drug test absent a confirmation test, which shall be
				  reimbursed in addition to the initial screening test. Merely duplicate
				  screenings or tests which are rerun to confirm initial results are not
				  otherwise eligible for reimbursement.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › GENERAL RULES › Section 20-2-XIII - MILEAGE REIMBURSEMENT (MCA Section 71-3-15; MISS. WORK COMP. COM. GENERAL RULE 1.14)

Current through June 25, 2024
The payer shall reimburse each claimant for all travel to
				  obtain medical treatment which is being obtained under the provisions of the
				  Mississippi Workers' Compensation Law, including travel to a pharmacy to obtain
				  medication or supplies necessary for treatment of a compensable injury,
				  regardless of the number of miles traveled. There is no minimum distance of
				  travel required for reimbursement, and reimbursement shall be made for each
				  mile of round trip travel necessitated by the compensable injury, at the rate
				  adopted by the MWCC and in effect at the time of the travel. Only reasonable
				  and necessary miles traveled are subject to reimbursement.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › GENERAL RULES › Section 20-2-XV - PATIENT'S RIGHT TO HEARING

Current through June 25, 2024
Nothing provided in this Fee Schedule shall estop or prevent
				  the patient from obtaining legal counsel and/or seeking relief in the form of a
				  request to compel medical treatment before an Administrative
				  Judge.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › GENERAL RULES › Section 20-2-XVII - Investigational Procedures

Current through June 25, 2024
The following procedures are considered investigational, and,
				  therefore, do not presently qualify for reimbursement under the
Mississippi Workers' Compensation Medical Fee Schedule
:
A. Intradiscal electrothermal therapy
				(IDET) (22526, 22527) and intradiscal annuloplasty by other method (22899).
B. Intraventricular administration
				of morphine.
C. Pulse
				radiofrequency, regardless of procedure involved or indication (e.g., medial
				branch radiofrequency, dorsal root radiofrequency, etc.). If pulsed
				radiofrequency is used, but not specifically recorded as such in the medical
				records, the payer may retroactively deny payment for the service and request
				for reimbursement from the provider.
D. Intradiscal therapies used in discography,
				such as percutaneous disc decompression (Dekompressor), fluoroscopic, laser,
				radiofrequency, and thermal disc therapies.
E. Percutaneous disc nucleoplasty.
F. Epidural adhesiolysis, also known as Racz
				procedure or lysis of epidural adhesions.
G. X-STOP fusion devices.
H. MILD (minimally invasive lumbar
				decompression) procedures.
I.
				Non-invasive pain procedure (NIP procedure or NIPP).
J. Alpha-stim unit.
K. ReBuilder and low laser treatment.
L. Botox for the use of
				musculoskeletal pain.
M. Ketamine
				infusion therapy.
N. Plasma rich
				protein (PRP) injections
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › BILLING AND REIMBURSEMENT RULES › Section 20-2-III - INSTRUCTIONS TO PAYERS

Current through June 25, 2024
A. An
				employer's/payer's payment shall reflect any adjustments in the bill made
				through the employer's/payer's bill review program. The employer/payer must
				provide an explanation of review (EOR) to a health care provider whenever
				reimbursement differs from the amount billed by the provider. This must be done
				individually for each bill.
B. In a
				case where documentation does not indicate the service was performed, the
				charge for the service may be denied. The EOR must clearly and specifically
				indicate the reason for the denial.
C.
(1) When
				a billed service is documented, but the code selected by the provider is not,
				in the payer's/reviewer's estimation, the most accurate code available to
				describe the service, the reviewer must not deny payment, but shall reimburse
				based on the revised code. The EOR must clearly and specifically detail the
				reason(s) for recoding the service or otherwise altering the claim. No claim
				shall be recoded or otherwise revised or altered without the payer having
				actually reviewed the medical records associated with the claim which document
				the service(s) provided.
(2) As an
				alternative to recoding or altering a claim, the payer may treat the matter
				under rule E(1) and (2) below by paying any undisputed portion of the bill, and
				notifying the provider by EOR that the remaining parts of the bill are denied
				or disputed.
(3) Recoding cannot be
				used solely for cost containment. Recoding may only be used for the correction
				of miscoded services. Whenever there is any dispute concerning coding, the
				provider must be notified immediately and given the opportunity to furnish
				additional information, although nothing herein suspends the time periods for
				making payment or giving notice of dispute. Any recoding or so-called "down
				coding," which is found by the MWCC or its Cost Containment Division to be
				solely for the purpose of cost containment, will subject the party engaging in
				such conduct to additional penalties as allowed by law.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › BILLING AND REIMBURSEMENT RULES › Section 20-2-IV - FACILITY FEE RULES

Current through June 25, 2024
Please refer to the Pain Management section for the
				  state-specific facility reimbursement rules to be used for outpatient pain
				  management procedures.
Please refer to the Inpatient Hospital and Outpatient
				  Facility Payment Schedule and Rules section for the state-specific facility
				  reimbursement rules to be used for ambulatory surgery center (ASC) procedures
				  and hospital based outpatient departments.
Implantables.
An implantable is an item that is
				  implanted into the body for the purpose of permanent placement, and remains in
				  the body as a fixture. Absorbable items, temporary items, or other items used
				  to help place the implant, are not within the definition of "implantable" and
				  are not reimbursed as such.
Implantables are included in the applicable MS-DRG
				  reimbursement for inpatient treatment, and, therefore, the provider of
				  inpatient services is not required to furnish the payer with an invoice for
				  implantables. For implantables used in the outpatient setting, reimbursement is
				  likewise included in the APC Amount paid to the facility. No separate billing
				  or payment for implants shall be made in either the inpatient or outpatient
				  setting.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › MEDICAL RECORDS RULES › Section 20-2-I - MEDICAL RECORDS

Current through June 25, 2024
A. The medical
				record, which documents the patient's course of treatment, is the
				responsibility of the provider and is the basis for determining medical
				necessity and for substantiating the service(s) rendered; therefore, failure to
				submit necessary or adequate documentation to support the services rendered may
				result in the services being disallowed.
B. A medical provider may not charge any fee
				for completing a medical report or form required by the MWCC which is part of
				the required supporting documentation which accompanies a request for payment.
				The supporting documentation that is required to substantiate the medical
				treatment is included in the fee for service and does not warrant a separate
				fee as it is incidental to providing medical care. CPT code 99080 is
				appropriate for billing special reports beyond those required by this Fee
				Schedule and requested by the payer or their representatives.
C. Medical records must be legible and
				include, as applicable:
1. Initial office
				visit notes which document a history, physical examination, assessment and plan
				appropriate to the level of service indicated by the presenting injury/illness
				or treatment of the ongoing injury/illness;
2. Progress notes which reflect patient
				complaints, objective findings, assessment of the problem, and plan of care or
				treatment;
3. Copies of lab, x-ray,
				or other diagnostic tests that reflect current progress of the patient and/or
				response to therapy or treatment;
4.
				Physical medicine/occupational therapy progress notes that reflect the
				patient's response to treatment/therapy;
5. Operative reports, consultation notes with
				report, and/or dictated report; and
6. Impairment rating (projected and actual)
				and anticipated maximum medical improvement (MMI) date.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › MEDICAL RECORDS RULES › Section 20-2-III - HEALTH INSURANCE PORTABILITY & ACCOUNTABILITY ACT (HIPAA) AND WORKERS' COMPENSATION

Current through June 25, 2024
HIPAA makes important exceptions concerning the disclosure of
				  protected health information (PHI) for workers' compensation purposes. The
				  United States Department of Health and Human Services, through its Office for
				  Civil Rights, enforces the HIPAA Law and maintains an informative website with
				  information on HIPAA and its application to workers' compensation claims. For
				  additional information, refer to the MWCC website (mwcc.ms.gov), or consult an
				  attorney and/or the HIPAA resource site maintained by the U. S. Department of
				  Health and Human Services (http://www.hhs.gov/ocr/privacy/ [File Link Not
				  Available]).
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › DISPUTE RESOLUTION RULES › Section 20-2-I - GENERAL PROVISIONS

Current through June 25, 2024
A. Unresolved
				disputes over the amount charged for services rendered under the provisions of
				the Fee Schedule or over the amount of reimbursement for services rendered
				under the Fee Schedule may be appealed to and resolved by the MWCC. Regardless
				of the date of service, all changes to the dispute resolution procedures found
				in this edition of this section of the Fee Schedule shall be applied
				retroactively to all Requests for Resolution of Dispute or other documents
				filed on or after the effective date of this Fee Schedule.
B. Reconsideration must be sought by the
				provider or payer prior to a request for resolution of a dispute being sent to
				the MWCC. This provides the payer and provider an opportunity to resolve most
				concerns in a timely manner.
C.
				All communication between parties in dispute will be handled by the MWCC, Cost
				Containment Division. In addition, there will be no communication between the
				parties in dispute and any Peer Reviewer who might be called upon to assist the
				MWCC in the resolution of a dispute.
D. In the absence of any agreement between
				the parties submitted to the MWCC in writing, Requests for Resolution of
				Dispute shall not be ruled upon in claims for which the compensability of the
				underlying injury is currently disputed or denied by the payer. In the event
				the parties submit such an agreement, it shall be subject to the review and
				approval of the Cost Containment Division, and such agreement shall be
				recognized or denied in the sole discretion of the Cost Containment Division
				and/or the MWCC. Otherwise, Cost Containment Decisions for Requests for
				Resolution of Dispute may be held in abeyance pending a final adjudication
				and/or admission of compensability by the payer for the underlying injury in
				the dispute.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › DISPUTE RESOLUTION RULES › Section 20-2-II - FORMS AND DOCUMENTATION

Current through June 25, 2024
A. Valid requests
				for resolution of a dispute must be submitted on the "Request for Resolution of
				Dispute" form (see the Forms section or
				http://www.mwcc.ms.gov/#/medicalFeeSchedule [File Link Not Available]) along
				with the following:
1. Copies of the original
				and resubmitted bills in dispute that include dates of service, procedure
				codes, charges for services rendered and any payment received, and an
				explanation of any unusual services or circumstances;
2. EOR including the specific reimbursement;
3. Supporting documentation and
				correspondence;
4. Specific
				information regarding contact with the payer; and
5. Any other information deemed relevant by
				the applicant for dispute resolution.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › DISPUTE RESOLUTION RULES › Section 20-2-III - TIME FOR FILING

Current through June 25, 2024
A Request for Resolution of Dispute must be filed with the
				  MWCC within thirty (30) days following the payer's or provider's response to a
				  request for reconsideration of any matter in dispute, or, in cases where the
				  payer or provider fails to respond to a request for reconsideration, within
				  thirty (30) days of the expiration of the time in which said response should
				  have been provided. Failure to file a Request for Resolution of Dispute within
				  this time shall bar any further action on the disputed issue(s) unless, for
				  good cause shown, the MWCC or its Cost Containment Director extends the time
				  for filing said request. In no event will a Request for Resolution of Dispute
				  be considered by the Cost Containment Division if submitted more than one (1)
				  year after the date of service. The decision to extend the time for filing a
				  Request for Resolution of Dispute based on "good cause" shall be entirely at
				  the discretion of the MWCC or its Cost Containment Director. Mere neglect will
				  not constitute "good cause."
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › DISPUTE RESOLUTION RULES › Section 20-2-IV - PROCEDURE BY COST CONTAINMENT DIVISION

Current through June 25, 2024
A. Requests for
				dispute resolution will be reviewed and decided by the Cost Containment
				Division of the MWCC after all required and requested information has been
				received. Additional time may be required to accommodate a Peer Review. The
				payer and/or provider may be contacted by telephone or other means for
				additional information if necessary; however, both parties to a dispute may
				submit in writing any information or argument they deem relevant to the issue
				in dispute, if not already submitted with the request for dispute resolution,
				and this information shall be considered by the Cost Containment Division when
				rendering a decision. Any written information or argument submitted for
				consideration by a party to a dispute, without a request from the MWCC, must be
				received by the Cost Containment Division within twenty-three (23) days after
				filing the Request for Resolution of Dispute in order to merit consideration.
				Unlike the Request for Resolution of Dispute Form, there is no specific
				prescribed form for a Response to such Request.
B. Every effort should be made by the parties
				to resolve disputes between themselves by telephone or in writing even after
				the filing of a Request for Resolution of Dispute. The payer and provider may
				be requested to attend an informal hearing conducted by a MWCC representative.
				Failure to appear at an informal hearing may result in dismissal of the Request
				for Resolution of Dispute. However, no formal hearing or oral argument shall be
				allowed unless requested by the Cost Containment Division and/or the MWCC.
				Otherwise, Requests for Resolution of Dispute shall be heard and considered
				solely on the record provided by the parties in the documentation they have
				submitted to the Cost Containment Division and any arguments they have made
				therein, without any oral argument or formal hearing.
C. Following review of all documentation
				submitted for dispute resolution and/or following contact with the payer and/or
				provider for additional information and/or negotiation, the Cost Containment
				Division shall render an administrative decision on the request for dispute
				resolution and forward it to the involved parties.
D. Cases involving medical care determination
				may be referred for peer review, but only on request of the MWCC. The peer
				review consultant will render an opinion and submit same to the MWCC
				representative within the time set by the Cost Containment Division. The MWCC
				representative will notify the parties in dispute if a Peer Review has been
				requested, and of the peer review consultant's determination.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › AUTHORIZATION/PRE-CERTIFICATION RULES › Section 20-2-I - SERVICES REQUIRING MANDATORY PRE-CERTIFICATION

Current through June 25, 2024
A. All elective
				admissions to inpatient facilities of any type.
B. All elective surgical procedures,
				inpatient and outpatient. (All surgical or other invasive procedures which are
				administered in the context of pain management treatment shall be regulated by
				the specific guidelines set forth in the Pain Management section of the Fee
				Schedule. Only in the event a surgically invasive pain management procedure is
				not specifically addressed in the Pain Management guidelines shall the
				provisions in this section control.)
C. Pain Management Procedures. Repeat MRI
				scans, repeat CT Scans, repeat EMG/NCS studies, and repeat myelograms (meaning
				more than one such diagnostic procedure which is being prescribed for the same
				injury) are subject to mandatory precertificiation, except that where surgery
				has been performed following proper approval, the treating physician is
				entitled to obtain one repeat of the aforementioned diagnostic procedures
				post-surgery without having to obtain separate approval for each such
				procedure. In other words, surgical cases merit two diagnostic procedures of
				the kind listed herein without the necessity of pre-certification provided one
				procedure occurs prior to surgical treatment and one procedure occurs
				post-surgical treatment. The two diagnostic procedures selected by the treating
				provider hereunder may be the same two diagnostic procedures, or any two of the
				aforementioned procedures.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › AUTHORIZATION/PRE-CERTIFICATION RULES › Section 20-2-II - SERVICES THAT MAY REQUIRE PRE-CERTIFICATION

Current through June 25, 2024
The following medical procedures may require
				  pre-certification by the payer. The payer may, at its discretion, require
				  review by a utilization review agent. If a utilization review agent is not
				  used, the review must be based on evidence-based practice standards. Any
				  adverse determination must have concurrence of a physician of the same
				  specialty and licensed to practice in Mississippi. If the payer requires review
				  by a utilization review agent and receives an adverse determination, the payer
				  may override the decision and authorize the series(s).
A. Physical medicine treatments after and 15
				visits and/or 30 days post-operatively;
B. Rental or purchase of supplies or
				equipment over the amount of $300.00 per item;
C. Rental or purchase of TENS;
D. Home health services;
E. Pain clinic/therapy programs, including
				interdisciplinary pain rehabilitation programs;
F. External spinal stimulators;
G. Pain control programs;
H. Work hardening programs, functional
				capacity testing, ISO kinetic testing;
I. Orthotics or prosthetics;
J. Psychological
				testing/counseling/treatment;
K.
				Substance abuse program;
L. Weight
				reduction program;
M. Any
				non-emergency medical service outside the State of Mississippi;
N. Repeat MRI, repeat CT scan, repeat
				EMG/NCS, and repeat myelogram (more than once per injury and/or more than one
				post-operatively); and
O. Massage
				therapy, acupuncture and biofeedback.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › MODIFIER AND CODE RULES › Section 20-2-III - MODIFIERS FOR HCPCS CODES

Current through June 25, 2024
This section contains a list of modifiers that are commonly
				  used with HCPCS DME codes.
AU Item Furnished in Conjunction with a
				  Urological, Ostomy, or Tracheostomy Supply
AV Item Furnished in Conjunction with a
				  Prosthetic Device, Prosthetic, or Orthotic
AW Item Furnished in Conjunction with a
				  Surgical Dressing
KC Replacement of Special Power Wheelchair
				  Interface
NU New Equipment
RR Rental (use the RR modifier when DME is to
				  be rented)
Mississippi guideline: Listed amount is the per month
				  allowance, except codes E0676, E0935, and E0936, which are per-day
				  allowances.
UE: Used Durable Medical
				  Equipment
Mississippi guideline: Used to report the purchase of
				  used durable medical equipment.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › MODIFIER AND CODE RULES › Section 20-2-IV - PROCEDURE CODE EXCEPTIONS

Current through June 25, 2024
A.
Unlisted
				Procedure Codes.
If a procedure is performed that is not listed in the
				Fee Schedule, the provider must bill with the appropriate "Unlisted Procedure"
				code and submit a narrative report to the payer explaining why it was medically
				necessary to use an unlisted procedure code.
The CPT book contains codes for unlisted procedures. Use
				  these codes only when there is no procedure code that accurately describes the
				  service rendered. A report is required as these services are reimbursed by
				  report (see below).
B.
By Report (BR) Codes.
By report (BR) codes are used by payers to
				determine the reimbursement for a service or procedure performed by the
				provider that does not have an established maximum allowable reimbursement
				allowance (MRA)(MAR).
1. Reimbursement for
				procedure codes listed as "BR" must be determined by the payer based on
				documentation submitted by the provider in a special report attached to the
				claim form. The required documentation to substantiate the medical necessity of
				a procedure does not warrant a separate fee. Information in this report must
				include, as appropriate:
a. A complete
				description of the actual procedure or service performed;
b. The amount of time necessary to complete
				the procedure or service performed;
c. Accompanying documentation that describes
				the expertise and/or equipment required to complete the service or
				procedure.