If you treat patients with worker’s compensation claims, you need to be aware of a new law that will soon have an impact on your billing.
Beginning July 1, you can bill only one office visit for each repackaged legend drug prescribed. That means you can dispense only eight days of medication for a worker’s compensation patient.
“The law places limits on the number of days a repackaged legend drug may be dispensed, which begins on the date of injury or disablement and ends at the beginning of the eighth day after the date of the injury or disablement,” explained Mike Rinebold, ISMA director of Government Relations. “After that time period, patients must go to the pharmacy for medications.”
The measure, which passed during the last Indiana General Assembly, was opposed by the ISMA in its original form.
According to the National Council on Compensation Insurance (NCCI), Indiana is among the highest states for dispensing of repacked drugs. More than 15 percent of prescription drugs for worker’s compensation cases are physician-dispensed. Read the complete NCCI study here.
Specifics of the law
“With the lead from the Indiana Hospital Association, we were successful in removing harmful provisions like reducing the fee schedule,” explained Rinebold.
The law also distinguishes a medical service provider from a medical service facility on the basis of the provider’s billing form for Medicare reimbursement.
For medical facilities, worker’s compensation will be capped at 200 percent instead of the proposed 150 percent of Medicare rates on the dates of service, unless a pre-existing fee schedule was negotiated. This issue was a big point of discussion at the Statehouse, noted Rinebold.
|Robert Hagen, M.D., Lafayette
Lafayette orthopaedic physician Robert Hagen, M.D., who takes worker’s compensation cases, testified on the issue at the Statehouse. He said he is not pleased with the bill that was signed into law.
“Taking care of a worker’s compensation patient is more than twice as hard as caring for other patients due to the complexity of the situation, he explained. “I’m not sure that capping at twice the Medicare rates will save money as physicians may choose to see more patients adding more cost to the system.”
Raising the red flag
The worker’s compensation reimbursement issue is expected to return to the Statehouse next year, according to Rinebold. He encourages all physicians to prepare.
Dr. Hagen agrees. “We need to stay together and explain to our legislators what we are experiencing with these patients,” he said. “It’s important that we tell them where we are on this issue and that we can’t go any lower on reimbursement.”
Rinebold urges you to take action now by calling your legislators. He also advises you to join IMPAC, the ISMA’s political action committee.
“IMPAC is our megaphone, our collective voice, by which our members can support like-minded candidates for elected office,” he said.
Find details on the ISMA member benefits page or call the ISMA at (317) 261-2060 or (800) 257-4762.