North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-31 - Who may be reimbursed

Current through Supplement No. 393, July, 2024
1. Only
				treatment that falls within the scope and field of the treating allied health
				care professional's license to practice is reimbursable.
2. Paraprofessionals who are not
				independently licensed must practice under the direct supervision of a licensed
				allied health care professional whose scope of practice and specialty training
				includes the service provided by the paraprofessional, in order to be
				reimbursed.
3. Medical service
				providers may be refused reimbursement to treat cases under the jurisdiction of
				the organization.
4. Any entity
				operating under the authority of the federal government and granted authority
				to receive direct reimbursement for payments made for medical treatment
				determined to be related to the workers' compensation injury.
5. Reasons for holding a medical service
				provider ineligible for reimbursement include one or more of the following:
a. Failure, neglect, or refusal to submit
				complete, adequate, and detailed reports.
b. Failure, neglect, or refusal to respond to
				requests by the organization for additional reports.
c. Failure, neglect, or refusal to respond to
				requests by the organization for drug testing.
d. Failure, neglect, or refusal to observe
				and comply with the organization's orders and medical service rules, including
				cooperation with the organization's managed care vendors.
e. Failure to notify the organization
				immediately and prior to burial in any death if the cause of death is not
				definitely known or if there is question of whether death resulted from a
				compensable injury.
f. Failure to
				recognize emotional and social factors impeding recovery of
				claimants.
g. Unreasonable refusal
				to comply with the recommendations of board-certified or qualified specialists
				who have examined the claimant.
h.
				Submission of false or misleading reports to the organization.
i. Collusion with other persons in submission
				of false or misleading information to the organization.
j. Pattern of submission of inaccurate or
				misleading bills.
k. Pattern of
				submission of false or erroneous diagnosis.
l. Billing the difference between the maximum
				allowable fee set forth in the organization's fee schedule and usual and
				customary charges, or billing the claimant any other fee in addition to the fee
				paid, or to be paid, by the organization for individual treatments, equipment,
				and products.
m. Failure to include
				physical conditioning in the treatment plan. The medical service provider
				should determine the claimant's activity level, ascertain barriers specific to
				the claimant, and provide information on the role of physical activity in
				injury management.
n. Failure to
				include the injured worker's functional abilities in addressing return-to-work
				options during the recovery phase.
o. Treatment that is controversial,
				experimental, or investigative; which is contraindicated or hazardous; which is
				unreasonable or inappropriate for the work injury; or which yields
				unsatisfactory results.
p.
				Certifying disability in excess of the actual medical limitations of the
				claimant.
q. Conviction in any
				court of any offense involving moral turpitude, in which case the record of the
				conviction is conclusive evidence.
r. The excessive use, or excessive or
				inappropriate prescription for use, of narcotic, addictive, habituating, or
				dependency inducing drugs.
s.
				Declaration of mental incompetence by a court of competent
				jurisdiction.
t. Disciplinary
				action by a licensing board.