A number of items are newsworthy in recent weeks.? Without further delay…
- Recently filed Assembly Bill 1499 states that “The death of an injured worker due to opioid overdose would be compensable in situations where the injured worker was prescribed the painkilling drug as a result of a workplace injury.”
- In OnBoard, users can now see on their dashboard when an MTG confirmation is converted to an MTG Variance. This links the Confirmation PAR directly to the new Variance PAR allowing for quick access.
- Payers should not deny a provider bill that isn’t submitted on the new CMS-1500 form. However, if the CMS-1500 isn’t used, the provider isn’t eligible for HP-1 (dispute form).
- If the provider submits a PAR that is not related to the claim, it should still be reviewed for medical necessity and approved without prejudice if appropriate.
- The Board has heard payer requests to approve without prejudice at Level 1 and is listening. Previously, the expectation was always for a physician to make that decision.? Nothing is likely to change in the near term, but we’ll follow this.
- 803 KAR 25:195. (Utilization review, appeal of utilization review decisions, and medical bill audit) is in effect as of 1/3/2023.? This replaces 803 KAR 25:190.
- 803 KAR 25:190 was previously amended in 2021 to include a DWC Medical Director to review appeal decisions (similar to Tennessee).? However, the regs were found deficient.
- The primary changes to 803 KAR 25:195 include specific rules around a requirement to offer a peer-to-peer conference with the appealing medical provider.
- New UR rules that became effective 9/29/2022 require annual reports from registered Utilization Review Organizations (URO) by March 1, 2023.??
- UR rules and regulations are continuing to change - don’t get left behind.
- There are financial consequences if you / your vendor aren’t keeping up.
