Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › BILLING AND REIMBURSEMENT RULES › Section 20-2-II - INSTRUCTIONS TO PROVIDERS

Current through June 25, 2024
A. All bills for
				service must be coded with the appropriate CPT, CDT, HCPCS or state-specific
				code.
B. The medical provider must
				file the appropriate billing form and necessary documentation within twenty
				(20) days of rendering services on a newly diagnosed work-related injury or
				illness. Subsequent billings must be submitted at least every thirty (30) days,
				or within thirty (30) days of each treatment or visit, whichever last occurs,
				with the appropriate medical records to substantiate the medical necessity for
				continued services. Late billings will be subject to discounts, not to exceed
				one and one-half percent (1.5%) per month of the bill or part thereof which was
				not timely billed, from the date the billing or part thereof is first due until
				received by the payer. Any bill or part thereof not submitted to the payer
				within sixty (60) days after the due date under this rule shall be subject to
				an additional one-time only discount penalty equal to ten percent (10%) of the
				total bill or part thereof. Any bill for services rendered which is not
				submitted to the payer within one (1) year after the date of service, or date
				of discharge for inpatient care, will not be eligible or considered for
				reimbursement under this Fee Schedule, unless otherwise ordered by the MWCC or
				its Cost Containment Division.
C.
				When services were rendered by another qualified health care professional and
				billed under the physician's National Provider Identifier (NPI), the billing
				physician must sign the medical record. When the physician bills the E/M
				services, the physician must personally document that the physician performed
				the service or were physically present during the critical or key portions of
				the service furnished by the qualified health care professional, and the
				physician's participation in the management of the patient.
D. Fees in excess of the maximum allowable
				reimbursement (MAR) must not be billed to the employee, employer, or payer. The
				provider cannot collect any non-allowed amount (MCA §
									71-3-15(3)
				(Rev. 2000)).
E. If it is
				medically necessary to exceed the Fee Schedule limitations and/or exclusions,
				substantiating documentation must be submitted by the provider to the payer
				with the claim form.
F. If a
				provider believes an incorrect payment was made for services rendered, or
				disagrees for any reason with the payment and explanation of review tendered by
				the payer, then the provider may request reconsideration pursuant to the rules
				set forth herein.
G. If, after the
				resolution of a reconsideration request or a formal dispute resolution request,
				or otherwise, the provider is determined to owe a refund to the payer, the
				amount refunded shall bear interest at the rate of one and one-half percent
				(1.5%) per month from the date the refunded amount was first received by the
				provider, until refunded to the payer.