reglab/statecodes huggingface dataset:
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › ATTENDANT SERVICES › Section 296-23-250 - Massage therapy rules

Current through Register Vol. 24-14, July 15, 2024
Practitioners should refer to WAC
				  296-20-010 through
				  296-20-125 for general
				  information and rules pertaining to the care of workers. See WAC
				  296-20-125 for billing
				  instructions.
Refer to WAC
				  296-20-132 and
				  296-20-135 for information
				  regarding use of the conversion factors.
Massage therapy treatment will be permitted when given by a
				  licensed massage practitioner only upon written orders from the worker's
				  attending doctor. In addition, physician assistants may order massage therapy
				  under these rules for the attending doctor.
A progress report must be submitted to the attending doctor
				  and the department or the self-insurer following six treatment visits or one
				  month, whichever comes first. Massage therapy treatment beyond the initial six
				  treatments will be authorized only upon substantiation of improvement in the
				  worker's condition in terms of functional modalities, i.e., range of motion;
				  sitting and standing tolerance; reduction in medication; etc. In addition, an
				  outline of the proposed treatment program, the expected restoration goals, and
				  the expected length of treatment will be required.
Massage therapy in the home and/or places other than the
				  practitioners usual and customary business facilities will be allowed only upon
				  prior justification and authorization by the department or self-insurer.
No inpatient massage therapy treatment will be allowed when
				  such treatment constitutes the only or major treatment received by the worker.
				  See WAC 296-20-030 for further
				  information.
Massage therapy treatments exceeding once per day must be
				  justified by attending doctor.
Maximum daily reimbursement levels for massage therapy are
				  seventy-five percent of the maximum daily reimbursement levels for physical and
				  occupational therapy services that may be found in WAC
				  296-23-220 and
				  296-23-230.
Billing codes, reimbursement levels, and supporting policies
				  for massage therapy services are listed in the fee schedules.
Statutory Authority:
					 RCW
					 51.04.020(1) and
					 51.04.030. 08-09-120, §
					 296-23-250, filed 4/22/08, effective 7/1/08. Statutory Authority:
					 RCW
					  51.04.020 and
					 51.04.030. 05-18-030, §
					 296-23-250, filed 8/30/05, effective 10/1/05. Statutory Authority:
					 RCW
					  51.04.020,
					 51.04.030 and 1993 c 159.
					 93-16-072, § 296-23-250, filed 8/1/93, effective
					 9/1/93.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › INDEPENDENT MEDICAL EXAMINATION › Section 296-23-307

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
					 RCW
					  51.32.055,
					 51.32.112,
					 51.32.114,
					 51.36.060, and
					 51.36.070. 04-04-029, §
					 296-23-307, filed 1/27/04, effective
					 3/1/04.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › INDEPENDENT MEDICAL EXAMINATION › Section 296-23-308 - Scheduling case progress examinations

Current through Register Vol. 24-14, July 15, 2024
(1) Unless a case progress examination is
				requested by the attending provider, no case progress examination may be
				scheduled until 120 days have passed since the later of:
(a) The department or self-insurer's receipt
				of the claim; or
(b) The department
				or self-insurer's receipt of the last case progress examination report and
				additional treatment of the condition, if requested, has been
				authorized.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › INDEPENDENT MEDICAL EXAMINATION › Section 296-23-309 - How many examinations may be requested?

Current through Register Vol. 24-14, July 15, 2024
Unless explicitly required by statute, the total number of
				  examinations per claim is limited as follows:
(1) One complete examination including report
				prior to an order under
				RCW
				 51.52.050 or
				51.52.060 allowing or denying a new claim unless an additional examination is authorized
				by the department in state fund or self-insured cases;
(2) One complete examination including
				report(s) from all appropriate specialty(ies) for an impairment rating unless
				the prior rating examination determined a rating was premature and/or further
				treatment was needed and is authorized by the self-insured employer or
				department;
(3) One complete
				examination including report(s) from all appropriate specialty(ies) to
				adjudicate any application to reopen a claim under
				RCW
				 51.32.160 prior to a final order under
				RCW
				 51.52.050 or
				51.52.060 allowing or denying reopening of the claim, unless the department authorizes an
				additional examination in state fund and self-insured cases. Additional
				impairment rating examinations are allowed following each time a claim is
				reopened under
				RCW
				 51.32.160;
(4) One examination may be performed after
				any new medical issue is contended to resolve a new medical issue prior to a
				final order, under
				RCW
				 51.52.050 or
				51.52.060,
				accepting or denying responsibility of the condition, unless the department
				authorizes an additional examination in state fund and self-insured cases;
				and
(5) Additional examinations per
				case progress rules and to resolve appeals as outlined in WAC 296-23-308 and
				296-23-401.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › INDEPENDENT MEDICAL EXAMINATION › Section 296-23-312 - Can a provider conduct independent medical examinations (IMEs) for the department or self-insurer without an active IME provider number from the department?

Current through Register Vol. 24-14, July 15, 2024
No. Only doctors who possess an active IME provider number
				  can provide independent medical examinations for the department or
				  self-insurer. Providers must submit an IME provider application and be approved
				  by the department to receive this number.
Statutory Authority:
					 RCW
					 51.32.055,
					 51.32.112,
					 51.32.114,
					 51.36.060, and
					 51.36.070. 04-04-029, §
					 296-23-312, filed 1/27/04, effective
					 3/1/04.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › INDEPENDENT MEDICAL EXAMINATION › Section 296-23-322 - What boards are recognized by the department for independent medical examination (IME) provider approval?

Current through Register Vol. 24-14, July 15, 2024
The department accepts certifications from boards recognized
				  by the following as meeting the board certification requirements in WAC
				  296-23-317:
(1) American Board of Medical
				Specialties;
(2) American
				Osteopathic Association (AOA) Bureau of Osteopathic Specialties;
(3) American Podiatric Medical
				Association;
(4) American Dental
				Association.
Statutory Authority:
					 RCW
					 51.32.055,
					 51.32.112,
					 51.32.114,
					 51.36.060, and
					 51.36.070. 04-04-029, §
					 296-23-322, filed 1/27/04, effective
					 3/1/04.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › INDEPENDENT MEDICAL EXAMINATION › Section 296-23-327 - What other factors may the department's medical director consider in approving or disapproving an application for an independent medical examination (IME) provider number?

Current through Register Vol. 24-14, July 15, 2024
The department's medical director considers other factors in
				  approving or disapproving an IME application, including, but not limited to,
				  the following:
(1) Complaints about
				the provider;
(2) Quality of
				reports;
(3) Timeliness of
				reports;
(4) Charges regarding any
				crime, gross misdemeanor, felony or violation of statutes or rules by any
				administrative agency, court or board;
(5) Convictions of any crime, gross
				misdemeanor, felony or violation of statutes or rules by any administrative
				agency, court or board.
Statutory Authority:
					 RCW
					 51.32.055,
					 51.32.112,
					 51.32.114,
					 51.36.060, and
					 51.36.070. 04-04-029, §
					 296-23-327, filed 1/27/04, effective
					 3/1/04.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › INDEPENDENT MEDICAL EXAMINATION › Section 296-23-332 - What are the requirements for notifying the department or self-insurer if an independent medical examination (IME) provider has a change in status?

Current through Register Vol. 24-14, July 15, 2024
Providers must immediately notify the department of any
				  change in status that might affect their qualifications for an independent
				  medical examination (IME)provider number. The notification must be in writing.
				  Providers must include a copy of any charges or final orders if applicable.
				  Changes in status include, but are not limited to:
(1) Changes in time spent in direct patient
				care;
(2) Loss or restriction of
				hospital admitting or practice privileges;
(3) Changes affecting business requirements
				(WAC 296-23-317);
(4) Loss of board certification;
(5) Charges regarding any crime, gross
				misdemeanor, felony or violation of statutes or rules by any administrative
				agency, court or board;
(6)
				Convictions of any crime, gross misdemeanor, felony or violation of statutes or
				rules by any administrative agency, court or board;
(7) Temporary or permanent probation,
				suspension, revocation, or limitation placed on their license to practice by
				any court, board, or administrative agency in any state or foreign
				jurisdiction.
Statutory Authority:
					 RCW
					 51.32.055,
					 51.32.112,
					 51.32.114,
					 51.36.060, and
					 51.36.070. 04-04-029, §
					 296-23-332, filed 1/27/04, effective
					 3/1/04.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › INDEPENDENT MEDICAL EXAMINATION › Section 296-23-337 - For what reasons shall the department's medical director or designee suspend or terminate approval of an independent medical examination (IME) examiner or firm?

Current through Register Vol. 24-14, July 15, 2024
To ensure high quality independent medical examinations
				  (IMEs), the department's medical director or designee may, in the situations
				  described below, terminate, suspend, or inactivate approval of examiners or
				  firms (partnerships, corporations, or other legal entities) that derive income
				  from IMEs. IME providers must have an active provider account number to perform
				  IMEs or provide IME related services.
FOR EXAMINERS:
(1)
AUTOMATIC TERMINATION.
The
				department's medical director or designee may terminate approval of examiners
				in situations including, but not limited to, the following:
(a) Their license has been revoked in any
				jurisdiction.
(b) A final order or
				stipulation to informal disposition has been issued against the examiner by a
				state authority in any jurisdiction including, but not limited to, the
				Washington state department of health, when such charges involve conduct or
				behavior as defined in
				chapter
				18.130 RCW, Uniform
				Disciplinary Act. These include, but are not limited to:
(i) Sexually inappropriate conduct, behavior
				or language.
(ii) Behavior that
				puts a patient's safety or well-being at risk.
(c) The examiner has committed perjury or
				falsified documents provided to the department or insurer.
(d) The examiner has a criminal felony
				history in any jurisdiction.
(e)
				The examiner has failed to reapply every three years or when
				required.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › INDEPENDENT MEDICAL EXAMINATION › Section 296-23-342 - Are providers entitled to referrals from the department or self-insurer?

Current through Register Vol. 24-14, July 15, 2024
No. The department or self-insured employer refers
				  industrially injured or ill workers for independent medical examination (IME)
				  services at their sole discretion. No provider is entitled to referrals from
				  the referral source.
Statutory Authority:
					 RCW
					 51.32.055,
					 51.32.112,
					 51.32.114,
					 51.36.060, and
					 51.36.070. 04-04-029, §
					 296-23-342, filed 1/27/04, effective
					 3/1/04.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › INDEPENDENT MEDICAL EXAMINATION › Section 296-23-347 - What are the independent medical examination (IME) provider's responsibilities in an examination?

Current through Register Vol. 24-14, July 15, 2024
(1) The IME
				provider's responsibilities prior to the examination are to:
(a) Be familiar with the contents of the
				medical examiner's handbook;
(b)
				Review all claim documents provided by the department or self-insured
				employer;
(c) Contact the worker
				prior to the examination to confirm the appointment date, time and location;
				and
(d) Review the purpose of the
				examination and the questions to be answered in the examination
				report.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › INDEPENDENT MEDICAL EXAMINATION › Section 296-23-352 - Must the independent medical examination (IME) provider address job analyses (JAs) at the request of the department or self-insurer?

Current through Register Vol. 24-14, July 15, 2024
Job analyses (JAs) sent to the IME provider at the time of
				  the IME referral must be completed and submitted with the IME report. JAs
				  submitted within sixty calendar days after the IME must be completed and
				  returned within fourteen calendar days of receipt of the JAs.
Statutory Authority:
					 RCW
					 51.32.055,
					 51.32.112,
					 51.32.114,
					 51.36.060, and
					 51.36.070. 04-04-029, §
					 296-23-352, filed 1/27/04, effective
					 3/1/04.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › INDEPENDENT MEDICAL EXAMINATION › Section 296-23-357 - May an independent medical examination (IME) provider offer to provide ongoing treatment to the worker?

Current through Register Vol. 24-14, July 15, 2024
No. However, if a worker voluntarily approaches an IME
				  provider who has previously examined the worker and asks to be treated by that
				  provider, the provider can treat the worker. The provider must document that
				  the worker was aware of other treatment options.
Statutory Authority:
					 RCW
					 51.32.055,
					 51.32.112,
					 51.32.114,
					 51.36.060, and
					 51.36.070. 04-04-029, §
					 296-23-357, filed 1/27/04, effective
					 3/1/04.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › INDEPENDENT MEDICAL EXAMINATION › Section 296-23-358 - What happens when there is no approved independent medical exam (IME) provider in the specialty needed available in a reasonably convenient location for the worker?

Current through Register Vol. 24-14, July 15, 2024
When there is no approved examiner in the worker's community
				  or in a reasonably convenient location for the worker, the department or
				  self-insurer may make alternate arrangements for the examination including, but
				  not limited to:
(1) Considering
				whether a consultation might be a sufficient alternative;
(2) Using telemedicine where
				appropriate;
(3) Notifying the
				worker or their representative before scheduling the IME in the nearest
				location available. In this case:
(a) Travel
				must not exceed any travel restrictions imposed by the attending provider
				unless alternative methods of travel will overcome the travel
				limitations.
(b) The department or
				self-insured employer will assist the worker with travel accommodations when
				requested by the worker.
(c) Travel
				accommodations are paid by the department or self-insured employer as listed in
				the fee schedule.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › INDEPENDENT MEDICAL EXAMINATION › Section 296-23-359 - When is telemedicine appropriate for an independent medical exam (IME)?

Current through Register Vol. 24-14, July 15, 2024
(1) The following
				exams may be conducted via telehealth:
(a)
				Mental health;
(b)
				Dermatology;
(c) Speech when there
				is no documented hearing loss;
(d)
				Kidney function;
(e) Hematopoietic
				system;
(f) Endocrine.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › INDEPENDENT MEDICAL EXAMINATION › Section 296-23-362 - Independent medical examination (IME)-Accompanying person

Current through Register Vol. 24-14, July 15, 2024
(1) Workers can bring an adult observer to
				the IME to provide comfort and reassurance.
The accompanying person will not be compensated for
				  attending the examination by the department or self-insured employer. The
				  accompanying person must be unobtrusive at all times. Obtrusive behavior
				  includes, but is not limited to, verbally or physically interrupting,
				  interfering, or obstructing the examination in any way.
(2) The accompanying person cannot be:
(a) The worker's attorney, paralegal, any
				other legal representative, or any other personnel employed by the worker's
				attorney or legal representative; or
(b) The worker's attending provider, any
				other provider involved in the worker's care, or any other personnel employed
				by the attending provider or other provider involved in the worker's care.
The department may designate other conditions under which the
				  accompanying person is allowed to be present during the IME.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › INDEPENDENT MEDICAL EXAMINATION › Section 296-23-364 - Definition of notification process required for workers to record independent medical examinations (IME)

Current through Register Vol. 24-14, July 15, 2024
(1)
				After receipt of the IME appointment/assignment letter, but no less than seven
				calendar days before the date of the examination, the worker or their
				representative must provide written notice to the IME firm or an examiner not
				in a firm, as listed in the appointment/assignment letter, to inform of their
				intent to record the examination.
(2) Written notification of the workers'
				intent to record must be given for each IME appointment.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › INDEPENDENT MEDICAL EXAMINATION › Section 296-23-366 - Independent medical examination (IME)-Recording notification time frame

Current through Register Vol. 24-14, July 15, 2024
If notice is received less than seven calendar days prior to
				  the IME, a worker may record the examination
only if
the IME
				  provider waives the seven calendar day notification requirement. If
				  notification is received after 5:00 p.m., in the time zone of the examination
				  location, the notification is considered received the next calendar
				  day.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › INDEPENDENT MEDICAL EXAMINATION › Section 296-23-367 - May the worker videotape or audiotape the independent medical examination? (Repealed)

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
					 RCW
					  51.32.055,
					 51.32.112,
					 51.32.114,
					 51.36.060, and
					 51.36.070. 04-04-029, §
					 296-23-367, filed 1/27/04, effective
					 3/1/04.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › INDEPENDENT MEDICAL EXAMINATION › Section 296-23-372 - Can a worker file a complaint about a provider's conduct during an independent medical examination?

Current through Register Vol. 24-14, July 15, 2024
Workers can send written complaints about a provider's
				  conduct during an independent medical examination to the self-insurer or
				  department. Based on the nature of the complaint, the department may refer the
				  complaint to the department of health.
Statutory Authority:
					 RCW
					 51.32.055,
					 51.32.112,
					 51.32.114,
					 51.36.060, and
					 51.36.070. 04-04-029, §
					 296-23-372, filed 1/27/04, effective
					 3/1/04.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › INDEPENDENT MEDICAL EXAMINATION › Section 296-23-377 - If an independent medical examination (IME) provider is asked to do an impairment rating examination only, what information must be included in the report?

Current through Register Vol. 24-14, July 15, 2024
When doing an impairment rating examination, the IME provider
				  must first review the determination by the attending doctor that the worker has
				  reached maximum medical improvement (MMI).
(1) If, after reviewing the records, taking a
				history from the worker and performing the examination, the IME provider
				concurs with the attending doctor's determination of MMI, the impairment rating
				report must, at a minimum, contain the following:
(a) A statement of concurrence with the
				attending doctor's determination of MMI;
(b) Pertinent details of the physical or
				psychiatric examination performed (both positive and negative
				findings);
(c) Results of any
				pertinent diagnostic tests performed (both positive and negative findings).
				Include copies of pertinent tests with the report;
(d) An impairment rating consistent with the
				findings and a statement of the system on which the rating was based (for
				example, the AMA
Guides to the Evaluation of Permanent
				Impairment
and edition used, or the Washington state category rating
				system - refer to WAC
				296-20-19000 through
				296-20-19030 and WAC
				296-20-200 through
				296-20-690); and
(e) The rationale for the rating, supported
				by specific references to the clinical findings, especially objective findings
				and supporting documentation including the specific rating system, tables,
				figures and page numbers on which the rating was based.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › INDEPENDENT MEDICAL EXAMINATION › Section 296-23-381 - What rating systems are used for determining an impairment rating conducted by an independent medical examination (IME) provider?

Current through Register Vol. 24-14, July 15, 2024
The following table provides guidance regarding the rating
				  systems generally used. These rating systems or others adopted through
				  department policies should be used to conduct an impairment rating.
Overview of Systems for Rating Impairment
Rating System
Used for These Conditions
Form of the Rating
RCW  51.32.080
Specified disabilities: Loss by amputation, total
								loss of vision or hearing
Supply the level of amputation
AMA
Guides to the Evaluation of Permanent
								Impairment
Loss of function of extremities, partial loss of
								vision or hearing
Determine the percentage of loss of function, as
								compared to amputation value listed in
								RCW
								 51.32.080
Category Rating System
Spine, neurologic system, mental health,
								respiratory, taste and smell, speech, skin, or disorders affecting other
								internal organs
Select the category that most accurately indicates
								overall impairment
Total Bodily Impairment (TBI)
Impairments not addressed by any of the rating
								systems above, and claims prior to 1971
Supply the percentage of TBI
Statutory Authority:
					 RCW
					 51.32.055,
					 51.32.112,
					 51.32.114,
					 51.36.060, and
					 51.36.070. 04-04-029, §
					 296-23-381, filed 1/27/04, effective
					 3/1/04.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › INDEPENDENT MEDICAL EXAMINATION › Section 296-23-382 - What information must be included in an independent medical examination (IME) report?

Current through Register Vol. 24-14, July 15, 2024
(1) It is the
				department's intention to purchase objective examinations to ensure that sure
				and certain determinations are made of all benefits to which the worker might
				be entitled. The independent medical examination report must:
(a) Contain objective, sound and sufficient
				medical information;
(b) Document
				the review of the claim documents provided by the department or
				self-insurer;
(c) Document the
				worker's history and the clinical findings;
(d) Answer all the written questions posed by
				the department or self-insurer or include a description of what would be needed
				to address the questions;
(e)
				Include objective conclusions and recommendations supported by underlying
				rationale that links the medical history and clinical findings;
(f) Be in compliance with current department
				reporting policies; and
(g) Be
				signed by the IME provider performing the examination.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › INDEPENDENT MEDICAL EXAMINATION › Section 296-23-387 - What are the responsibilities of an independent medical examination (IME) provider regarding testimony?

Current through Register Vol. 24-14, July 15, 2024
IME providers must make themselves reasonably available to
				  testify at the board of industrial insurance appeals (board) or by deposition.
				  Reasonably available to all parties means cooperating in the timely scheduling
				  of the pretestimony conference and testimony and being available to testify
				  during business hours (7:00 a.m. to 6:00 p.m.) as ordered by the judge and
				  within the dates ordered by the board to complete testimony, unless a different
				  time is needed and agreed upon by all parties. In signing the application to be
				  an independent medical examination provider, the provider agrees to perform
				  examinations and be available to testify and to answer questions about the
				  medical facts of the case at rates established under the authority of
				  Washington industrial insurance law. The department may fine the firm and/or
				  examiner up to five hundred dollars per violation for failure to comply with
				  these requirements, whether the failure was intentional or not.
In addition, failure to comply with these requirements may
				  result in suspension or termination of the IME provider
				  number.
Statutory Authority:
					 RCW
					 51.32.055, 51, 32, 112 [51.32.112],51.32.114, 51.36.060, and 51.36.070. 09-24-085, § 296-23-387, filed 11/30/09,
					 effective 3/1/10; 04-04-029, § 296-23-387, filed 1/27/04, effective
					 3/1/04.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › INDEPENDENT MEDICAL EXAMINATION › Section 296-23-392 - Is there a fee schedule for independent medical examinations?

Current through Register Vol. 24-14, July 15, 2024
The maximum fee schedule for performing independent medical
				  examinations is published by the department in the
Medical Aid Rules
				  and Fee Schedule
available from the department.
Statutory Authority:
					 RCW
					 51.32.055,
					 51.32.112,
					 51.32.114,
					 51.36.060, and
					 51.36.070. 04-04-029, §
					 296-23-392, filed 1/27/04, effective
					 3/1/04.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › INDEPENDENT MEDICAL EXAMINATION › Section 296-23-401 - Can the department schedule an examination or order a self-insured employer to schedule an examination after receipt of an appeal to the board of industrial insurance appeals (BIIA)?

Current through Register Vol. 24-14, July 15, 2024
Following receipt of an appeal by any party, the department
				  may reassume and schedule, or may order the self-insured employer to schedule,
				  an examination.
The self-insured employer may also schedule an examination
				  regarding an appeal if a request has been approved by the department.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › INDEPENDENT MEDICAL EXAMINATION › Section 296-23-403 - Independent medical examinations-Department data reporting

Current through Register Vol. 24-14, July 15, 2024
The department will regularly provide independent medical
				  examination data to interested parties that includes emerging trends.
As much as possible, the data should include and
				  differentiate between examinations for claims insured by the department and
				  those covered by self-insured employers.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23A - Hospitals › Part 1 - GENERAL INFORMATION › Section 296-23A-0100 - Where can I find general information and rules pertaining to the care of workers?

Current through Register Vol. 24-14, July 15, 2024
Hospitals may find general information and rules pertaining
				  to the care of workers in chapters296-20, 296-21 and 296-23 WAC, department
				  bulletins and other department publications. This list is not exhaustive and
				  hospitals remain responsible for other applicable rules.
Statutory Authority:
					 RCW
					 51.04.020,
					 51.04.030 and
					 51.36.080. 97-06-066, §
					 296-23A-0100, filed 2/28/97, effective
					 4/1/97.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23A - Hospitals › Part 1 - GENERAL INFORMATION › Section 296-23A-0110 - When will the department or self-insurer pay for hospital services?

Current through Register Vol. 24-14, July 15, 2024
The department or self-insurer will pay for hospital services
				  when proper and necessary for the treatment of the accepted occupational
				  disease or injury.
See WAC
				  296-20-01002 for the definition
				  of medically necessary.
See WAC
				  296-20-075 for further rules
				  regarding hospitalization.
See WAC
				  296-20-03001 for treatment
				  requiring authorization.
See WAC
				  296-20-03002 for treatment not
				  authorized.
Statutory Authority:
					 RCW
					 51.04.020,
					 51.04.030 and
					 51.36.080. 97-06-066, §
					 296-23A-0110, filed 2/28/97, effective
					 4/1/97.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23A - Hospitals › Part 1 - GENERAL INFORMATION › Section 296-23A-0120 - What services are subject to review by the department or self-insurer?

Current through Register Vol. 24-14, July 15, 2024
The department uses utilization review criteria and all
				  hospital inpatient and outpatient services and billed charges are subject to
				  review by the department, self-insurer or a representative chosen by the
				  department or self-insurer.
Statutory Authority:
					 RCW
					 51.04.020,
					 51.04.030 and
					 51.36.080. 97-06-066, §
					 296-23A-0120, filed 2/28/97, effective
					 4/1/97.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23A - Hospitals › Part 1 - GENERAL INFORMATION › Section 296-23A-0130 - How does the department establish hospital payment rates?

Current through Register Vol. 24-14, July 15, 2024
The department will establish and update hospital payment
				  rates, methods and policies in consultation with interested persons at times
				  determined by the department. The department will publish a description of
				  payment methods, rates, and policies for hospital services at least thirty
				  calendar days prior to implementation.
Statutory Authority:
					 RCW
					 51.04.020,
					 51.04.030 and
					 51.36.080. 97-06-066, §
					 296-23A-0130, filed 2/28/97, effective
					 4/1/97.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23A - Hospitals › Part 1 - GENERAL INFORMATION › Section 296-23A-0140 - How can interested persons request advance notice of changes to hospital payment rates, methods and policies?

Current through Register Vol. 24-14, July 15, 2024
The department will give at least thirty calendar days notice
				  to interested persons who request advance notice of changes to hospital payment
				  rates, methods and policies. Interested persons may request advance notice by
				  contacting the department at the following address:
Department of Labor and Industries
Health Services Analysis
Mailing List for Hospital Payment Rates
P.O. Box 44322
Olympia, Washington 98504-4322
Statutory Authority:
					 RCW
					 51.04.020,
					 51.04.030 and
					 51.36.080. 97-06-066, §
					 296-23A-0140, filed 2/28/97, effective
					 4/1/97.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23A - Hospitals › Part 1.1 - SUBMITTING BILLS › Section 296-23A-0150 - How must hospitals submit bills for hospital services?

Current through Register Vol. 24-14, July 15, 2024
Hospitals must submit bills for hospital services using the
				  current National Uniform Billing Form (billing form), or electronically using
				  department file format specifications. Providers using the paper billing form
				  must follow both the billing instructions provided by the department and the
				  Washington state version of the
National Uniform Billing Data Element
				  Specifications
as adopted by the National Uniform Billing
				  Committee.
Statutory Authority:
					 RCW
					 51.04.020,
					 51.04.030 and
					 51.36.080. 97-06-066, §
					 296-23A-0150, filed 2/28/97, effective
					 4/1/97.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23A - Hospitals › Part 1.1 - SUBMITTING BILLS › Section 296-23A-0160 - How must hospitals submit charges for ambulance and professional services?

Current through Register Vol. 24-14, July 15, 2024
Hospitals must submit charges for ambulance services and
				  professional services provided by hospital staff physicians on the current
				  Health Insurance Claim Form (as defined by the National Uniform Claim
				  Committee), using the provider account number(s) assigned by the department for
				  these services. Hospitals using any of the electronic transfer options must
				  follow department instructions for electronic billing.
Statutory Authority:
					 RCW
					 51.04.020,
					 51.36.080,
					 7.68.030,
					 7.68.080. 07-08-088, §
					 296-23A-0160, filed 4/3/07, effective 5/23/07. Statutory Authority:
					 RCW
					  51.04.020,
					 51.04.030 and
					 51.36.080. 97-06-066, §
					 296-23A-0160, filed 2/28/97, effective
					 4/1/97.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23A - Hospitals › Part 1.1 - SUBMITTING BILLS › Section 296-23A-0170 - How must hospitals bill the department or self-insurer for preadmission services?

Current through Register Vol. 24-14, July 15, 2024
Preadmission services performed in a hospital outpatient
				  setting within one day prior to hospital admission must be billed as hospital
				  inpatient services.
Statutory Authority:
					 RCW
					 51.04.020,
					 51.04.030 and
					 51.36.080. 97-06-066, §
					 296-23A-0170, filed 2/28/97, effective
					 4/1/97.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23A - Hospitals › Part 1.2 - SUPPORTING DOCUMENTATION REQUIREMENTS › Section 296-23A-0180 - What supporting documentation must hospitals send for hospital services?

Current through Register Vol. 24-14, July 15, 2024
Hospitals must send the following supporting documentation
				  for hospital services:
Admission history and physical examination
Discharge summary for stays over forty-eight
								hours
Emergency room reports
Operative reports
Anesthesia records
Other documentation as requested by the department
								or self-insurer.
Hospitals must place the worker's name and claim number on
				  the upper right-hand corner of each page of supporting documentation
				  submitted.
Statutory Authority:
					 RCW
					 51.04.020,
					 51.04.030 and
					 51.36.080. 97-06-066, §
					 296-23A-0180, filed 2/28/97, effective
					 4/1/97.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23A - Hospitals › Part 1.2 - SUPPORTING DOCUMENTATION REQUIREMENTS › Section 296-23A-0190 - Where must hospitals send supporting documentation for hospital services for state fund claims?

Current through Register Vol. 24-14, July 15, 2024
Do not submit supporting documentation with the bill for
				  services. Hospitals must send supporting documentation for hospital services
				  for state fund claims to:
Department of Labor and Industries
Claims Section
P.O. Box 44291
Olympia, WA 98504-4291
Statutory Authority:
					 RCW
					 51.04.020,
					 51.04.030 and
					 51.36.080. 97-06-066, §
					 296-23A-0190, filed 2/28/97, effective
					 4/1/97.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23A - Hospitals › Part 1.2 - SUPPORTING DOCUMENTATION REQUIREMENTS › Section 296-23A-0195 - When must providers using electronic medium submit supporting documentation?

Current through Register Vol. 24-14, July 15, 2024
Providers using any of the electronic transfer options
				  provided by the department must send the department or self-insurer the
				  required supporting documentation within thirty calendar days of the date
				  billing information was sent to the department on electronic medium. Providers
				  must comply with the electronic billing instructions supplied by the department
				  regarding the submission of hospital bill documentation.
Statutory Authority:
					 RCW
					 51.04.020,
					 51.04.030 and
					 51.36.080. 97-06-066, §
					 296-23A-0195, filed 2/28/97, effective
					 4/1/97.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23A - Hospitals › Part 2 - PAYMENT METHODS FOR HOSPITAL SERVICES › Section 296-23A-0200 - How does the department pay for hospital inpatient services?

Current through Register Vol. 24-14, July 15, 2024
The department will pay for hospital inpatient services
				  according to the following table:
Hospital Type or Location
Do Diagnosis Related Group (DRG) payment
								methods apply?
Do per diem payment methods
								apply?
Do percent of allowed charges (POAC)
								payment methods apply to hospital inpatient services?
Children's Hospitals
No
No
Yes, paid 100% of allowed charges
Chronic Pain Management Program
Exempt, paid per department agreement.
Exempt, paid per department agreement.
Exempt, paid per department agreement.
Health Maintenance Organizations
No
No
Yes, paid 100% of allowed charges
Military
No
No
Yes, paid 100% of allowed charges
Veterans Administration
No
No
Yes, paid 100% of allowed charges
State psychiatric facility
No
No
Yes, paid 100% of allowed charges
All other Washington hospitals
Yes
Yes, statewide average per diem rates apply for
								designated categories: Chemical dependency, psychiatric, rehabilitation, low
								volume medical, and low volume surgical DRGs
Yes, applies to low cost outlier payments and high
								cost outlier payments above the high cost outlier threshold
Statutory Authority:
					 RCW
					 51.04.030 and 51.12.330. 06-12-073, §
					 296-23A-0200, filed 6/6/06, effective 7/7/06. Statutory Authority:
					 RCW
					  51.04.020,
					 51.04.030,
					 51.36.080. 00-06-027, §
					 296-23A-0200, filed 2/24/00, effective 3/26/00; 97-06-066, § 296-23A-0200,
					 filed 2/28/97, effective 4/1/97.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23A - Hospitals › Part 2 - PAYMENT METHODS FOR HOSPITAL SERVICES › Section 296-23A-0210 - How do self-insurers pay for hospital inpatient services?

Current through Register Vol. 24-14, July 15, 2024
Self-insurers will pay for hospital inpatient services using
				  percent of allowed charges (POAC) factors, according to the following
				  table:
Hospital Type or Location
Do percent of allowed charges (POAC)
								payment methods apply to hospital inpatient services?
Military, Veteran's Administration, Health
								Maintenance Organizations, State Psychiatric Facilities, Children's
								Hospitals
Yes, paid 100% of allowed charges
All other Washington hospitals
Yes, paid the hospital specific POAC factor
Statutory Authority:
					 RCW
					 51.04.020,
					 51.04.030,
					 51.36.080. 00-06-027, §
					 296-23A-0210, filed 2/24/00, effective 3/26/00; 97-06-066, § 296-23A-0210,
					 filed 2/28/97, effective 4/1/97.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23A - Hospitals › Part 2 - PAYMENT METHODS FOR HOSPITAL SERVICES › Section 296-23A-0221 - How does the self-insurer pay for hospital outpatient services?

Current through Register Vol. 24-14, July 15, 2024
The self-insurer will pay for hospital outpatient services
				  according to the following table:
Hospital Type or Service
								Location
Do percent of allowed charges (POAC)
								payment methods apply?
Do the department's Medical Aid Rules and
								Fee Schedules apply to hospital outpatient radiology, laboratory, pathology,
								occupational therapy, and physical therapy services?
Children's hospitals
Yes, paid 100% of allowed charges
Yes
Chronic Pain Management Program
Not Applicable
Not Applicable
Health Maintenance Organizations
Yes, paid 100% of allowed charges
Yes
Military
Yes, paid 100% of allowed charges
No, paid 100% of allowed charges
Veterans Administration
Yes, paid 100% of allowed charges
No, paid 100% of allowed charges
State psychiatric facility
Yes, paid 100% of allowed charges
Yes
Other psychiatric hospitals
Yes, applies to hospital outpatient services except
								radiology, laboratory, pathology, occupational therapy, and physical
								therapy
Yes
Rehabilitation hospitals
Yes, applies to hospital outpatient services except
								radiology, laboratory, pathology, occupational therapy, and physical
								therapy
Yes
Cancer hospitals
Yes, applies to hospital outpatient services except
								radiology, laboratory, pathology, occupational therapy, and physical
								therapy
Yes
All other Washington hospitals
Yes, applies to hospital outpatient services except
								radiology, laboratory, pathology, occupational therapy, and physical
								therapy
Yes
Hospitals are reimbursed only for the technical component of
				  rates listed in the fee schedules, for outpatient radiology, pathology and
				  laboratory services.
See chapter 296-23 WAC for rules on radiology,
				  pathology, laboratory, physical therapy, occupational therapy, and work
				  hardening services.
See WAC 296-23A-700 for rules on the prospective
				  payment system for hospital outpatient services.
See WAC
				  296-20-132 and
				  296-20-135 for information on the
				  conversion factor used for certain hospital outpatient
				  services.
Statutory Authority:
					 RCW
					 51.04.030 and 51.12.330. 06-12-073, §
					 296-23A-0221, filed 6/6/06, effective 7/7/06. Statutory Authority:
					 RCW
					  51.04.020,
					 51.04.030,
					 51.36.080,
					 51.36.085. 01-24-045, §
					 296-23A-0221, filed 11/29/01, effective
					 1/1/02.