FEE SCHEDULE NEWS:

• The state has adopted changes to the Physician Drug, Ambulatory Surgical Centers, Outpatient and Medical Provider Fee Schedule effective October 1, 2017. The next expected update is set for January 1, 2018.

REGULATORY ACTIVITY:

• WSI recently revised the Advanced Beneficiary Notice of Non-Coverage (ABN) form, which a provider should use effective immediately. Revisions include general formatting changes and the addition of an “other” section, which allows a provider to identify other non-reimbursable services or items not previously listed on the ABN.
• A provider may use the ABN form to inform an injured worker about the costs associated with services WSI may not cover. The ABN allows an injured worker to decide whether to obtain the service or item in question and to accept financial responsibility if WSI denies coverage. WSI recommends obtaining a signed ABN form prior to providing the following to an injured worker:
  • Services and items not allowed, or which exceed statutory limitations, per North Dakota Administrative Code (link is external) (e.g. Game Ready, acupuncture, trigger point injections)
  • Medical equipment and supplies, which are no longer medically necessary but an injured worker wishes to keep or continue receiving
  • Services denied in advance by WSI's Utilization Review department or the claim adjuster
  • Upgrades to medically necessary services or items, which are not medically necessary (e.g. luxury eye glass frames or lenses options)
• Use of the ABN form does not waive WSI’s requirement that a provider submits all charges related to a worker’s compensation injury to WSI for medical bill auditing. To bill charges for which a signed ABN is present, append modifier GA to each applicable bill line and submit to WSI with medical documentation and the ABN form. WSI will review all charges and documentation to make the most appropriate payment determination for each charge. A provider may only bill a patient or other insurance when specified by WSI’s remittance advice reason codes.
• If you have questions please send an email to wsipr@nd.gov (link sends e-mail).

LEGISLATIVE ACTIONS:

• House Bill 1235
  The enacted legislation establishes that workers’ compensation records are confidential however the records may be made available to legal counsel for indigents.  Effective Date August 1, 2017.

REGULATORY ACTIVITY:

• North Dakota adopted amendments to Chapter 92-01-02 Rules of Procedure North Dakota Workers' Compensation Act that became effective July 1, 2017.

FEE SCHEDULE NEWS:

• The state has adopted changes to the Physician Drug, Clinical Laboratory and Medical Provider Fee Schedule effective July 1, 2017. The next expected update is set for October 1, 2017.
• Effective July 1, 2017 WSI will implement the use of the 3M Ambulatory Payment Classification (APC) grouper. The APC grouper will enable WSI to incorporate additional Medicare APC methodologies into outpatient hospital reimbursements, including: Unconditional packaging; Conditional packaging; Composite APC packaging; and Comprehensive APC packaging.  WSI will begin processing bills utilizing the new APC grouper methodology for dates of service on or after July 1, 2017. To offset the impact of the increased APC payment packaging, WSI will provide a one-time increase of 6.28% to the Outpatient Hospital Fee Schedule conversion factor. As a result, the new conversion factor will be set to $142.10 for the remainder of 2017. WSI will update the Outpatient Hospital Fee Schedule Guideline to include the new conversion factor, as well as new status indicators and payment parameters. The guideline will be available to coincide with the release of the APC grouper. A provider should refer to the revised guideline for complete information.  If you have questions about this article, please send an email to wsipr@nd.gov (link sends e-mail).  To receive provider news, subscribe to our Email Updates list.
• WSI has published the New Guideline for Ambulatory Surgery Center Fee Schedule Guidelines effective July 1, 2017.

REGULATORY ACTIVITY:

• WSI recently revised several Utilization Review (UR) forms, which a provider should use effective immediately. Revisions include general formatting/ language changes and conversion to a fill able PDF version. Listed below are the updated forms and a summary of any additional revisions:
  • Independent Exercise Form (C59a)
  • Work Hardening/Conditioning Form (C59b)
  • Utilization Review Request Form (UR-C): Revision of Section 7, Injection Request, and Section 8, Therapy Request
  • Utilization Review Chiropractor Request Form (UR-Chiro): Revision of Section 3, Acute and Sub-Acute Care, and Section 4, Palliative Care
  • Medical Service Dispute Resolution Request Form (M2)
• As a reminder, a provider must complete these forms in their entirety, as WSI will return incomplete forms back to the provider. A provider may contact the UR department at 888-777-5871 with questions on UR form completion and prior authorization requirements.
• WSI has posted new fee schedules to become effective July 1, 2017.  The schedules published are Physician Drug, Clinical Laboratory and Medical Provider Fee Schedule.
• Effective July 1, 2017 WSI will implement the use of the 3M Ambulatory Payment Classification (APC) grouper. The APC grouper will enable WSI to incorporate additional Medicare APC methodologies into outpatient hospital reimbursements, including: Unconditional packaging; Conditional packaging; Composite APC packaging; and Comprehensive APC packaging.  WSI will begin processing bills utilizing the new APC grouper methodology for dates of service on or after July 1, 2017. To offset the impact of the increased APC payment packaging, WSI will provide a one-time increase of 6.28% to the Outpatient Hospital Fee Schedule conversion factor. As a result, the new conversion factor will be set to $142.10 for the remainder of 2017. WSI will update the Outpatient Hospital Fee Schedule Guideline to include the new conversion factor, as well as new status indicators and payment parameters. The guideline will be available to coincide with the release of the APC grouper. A provider should refer to the revised guideline for complete information.  If you have questions about this article, please send an email to wsipr@nd.gov (link sends e-mail).  To receive provider news, subscribe to our Email Updates list.
• WSI has published the New Guideline for Ambulatory Surgery Center Fee Schedule Guidelines effective July 1, 2017.

LEGISLATIVE ACTIONS:

• House Bill 1137
  The enacted legislation creates and enacts sections 65-04-26.2 and 65-04-27.2 of the North Dakota Century Code, relating to workers' compensation requirements for general contractors and cease and desist orders; to amend and reenact subsection 16 of section 65-01-02 and section 65-04-19 of the North Dakota Century Code, relating to the workers' compensation definition of employee, assignment of rate classification, and calculation of premium; and to provide a penalty. Effective Date August 1, 2017.

• House Bill 1156
  The enacted legislation amends and reenacts section 65-01-02, subsection 8 of section 65-05-07, and section 65-05-08 of the North Dakota Century Code, relating to the definition of medical marijuana and prohibiting the payment of workers' compensation benefits for medical marijuana; and to provide for application.  Effective Date August 1, 2017.

• House Bill 1235
  The legislation creates and enacts subsections 4 and 5 to section 54-61-02 of the North Dakota Century Code, relating to access to confidential records by the commission on legal counsel for indigents. Effective Date August 1, 2017.

• Senate Bill 2094
  This legislation creates and enacts section 65-04-04.4 of the North Dakota Century Code, relating to medical expense assessments; to amend and reenact sections 65-04-22, 65-04-26.1, 65-04-32, and subsections 2, 3, and 4 of section 65-04-33 of the North Dakota Century Code, relating to securing premium payments, correct cross references, employer noncompliance, and employer false statements; to repeal section 65-05-07.2 of the North Dakota Century Code, relating to medical expense assessments; and to provide a penalty.  Effective Date August 1, 2017.

• Senate Bill 2199
  The enacted legislation creates and enacts chapter 37-17.5 of the North Dakota Century Code, relating to facilitating entry of an out-of-state business to perform disaster or emergency remediation work in this state on critical natural gas, electrical, and telecommunication transmission infrastructure and to provide a limited exemption for that purpose from state and local taxes and fees, licensing, and other requirements during the time in this state employed in disaster or emergency remediation work. Effective Date August 1, 2017.

• Senate Bill 2231
  The enacted legislation creates and enacts a new section to chapter 23-16 and four new sections to chapter 26.1-47 of the North Dakota Century Code, relating to informed decision making for choosing air ambulance service providers, preferred provider arrangement requirements for insurance prior authorization for air ambulance services, and air ambulance subscriptions; to amend and reenact section 26.1-47-01, subsection 6 of section 26.1-47-02, and section 26.1-47-07 of the North Dakota Century Code, relating to preferred provider organizations; to provide an effective date; and to provide a contingent effective date.  Note on effective date: Sections 2, 4, 5, and 6 of this Act become effective January 1, 2018. If section 6 of this Act is declared invalid, sections 3, 7, and 8 of this Act become effective on the date the insurance commissioner certifies the invalidity of section 6 to the secretary of state and the legislative council.  Effective Date August 1, 2017.

REGULATORY ACTIVITY:

• The North Dakota WSI has adopted changes that a provider may submit professional charges (CMS-1500/837p) and documentation electronically to WSI through iHCFA. WSI is also working to implement submission of institutional charges (UB-04/837i) through iHCFA.
• iHCFA is a specialized clearinghouse that offers the electronic submission of bills, medical reports, and supporting documents to workers' compensation payers. This new billing option will result in quicker bill payment, confirmation reports of bill receipt, and elimination of paper and associated expenses for a provider.
• iHCFA provides the following options for submitting professional medical bills, which were not previously available:
  • Direct connection with WSI for medical bill and documentation submission
  • Online claim form interface, including documentation attachment
  • Indirect connection with a provider’s existing clearinghouse, dependent on the clearinghouse’s ability to meet certain technical requirements.
• A provider interested in submitting professional (CMS-1500/837p) bills via EDI must register with both WSI and iHCFA.
• To register with WSI, complete the Payee Registration and Substitute W-9 form. WSI requires a new or an existing provider complete this form prior to submitting through iHCFA. A provider must submit a Payee Registration and Substitute W-9 form for each business NPI they bill to WSI.
• To register with iHCFA, or for additional information, contact iHCFA at 973-795-1641 (option 2).
• WSI has adopted the AMA’s CPT® Guidelines for telemedicine services. Telemedicine seeks to improve a patient's health by permitting two-way, real time interactive communication between the patient and a physician or practitioner at a distant site. The CPT Guidelines indicate telemedicine services involve the use of interactive telecommunications equipment that, at a minimum, includes both audio and video. CPT codes approved for telemedicine are identifiable by the presence of a ★ symbol preceding the code. The AMA also collectively lists these services in Appendix P of the CPT Guidelines.  A provider should submit a claim for a telemedicine service using Place of Service (POS) code 02. Appropriate billing includes the CPT or HCPCS code for the professional service appended with modifier GT or 95. WSI issues reimbursement for the CPT code billed per WSI fee schedule, when deemed medically necessary and related to the work injury.  WSI also allows reimbursement for an originating site fee per WSI Fee Schedule. A provider should submit a claim for this service with HCPCS code Q3014 on a CMS-1500 using POS 02 or a UB-04 using type of bill 131.

FEE SCHEDULE NEWS:

• The state has adopted changes to the medical and hospital fee schedules effective April 1, 2017. The next expected update is set for July 1, 2017.

LEGISLATIVE ACTIONS:

• House Bill 1086
  The enacted legislation removes the requirement that a treating doctor be notified when an injured employee is notified of the intention to discontinue benefits. It also specifies how an overpayment of benefits can be recovered. The legislation also changes the amount involved regarding fraud for a class C felony from $500.00 to $1,000.00 regarding benefits. The legislation also makes non-substantial clerical changes to the statute.  Effective Date: August 1, 2017.

• Senate Bill 2048
  The enacted bill will serve to increase injured employee attorney fees in limited instances. It may also serve to increase the number of cases proceeding to an administrative hearing. The agency by rule will establish cost payable to the injured worker’s attorney. Effective Date: August 1, 2017.
• Senate Bill 2093
  The enacted legislation amends the statute relating to subrogation liens; provides that an interested party can request and WSI shall provide an appealable determination if WSI does not issue an order within 60 days of receiving a request for reconsideration; and updates Decision Review Office statute to conform to previous statutory changes. Effective Date: August 1, 2017.

FEE SCHEDULE NEWS:

• The state has adopted changes to the medical and hospital fee schedules effective January 1, 2017. The next expected update is set for April 1, 2017.

REGULATORY ACTIVITY:

• North Dakota has published the full version of their fee schedule and treatment guidelines.  The treatment guidelines include guidelines for Ambulance, Ambulatory Surgery Center, Anesthesia, Clinical Laboratory, Durable Medical Equipment, Home Health, Inpatient Hospital, Medical Provider, Outpatient Hospital and Physician Administered Drugs.
• WSI recently implemented Documentation Policies to reinforce existing guidelines and/or clarify documentation standards. The following three new policies outline WSI’s expectations of specific documentation components reviewed during the bill audit process.
• Evaluation and Management (E&M): This policy replaces the existing guidelines regarding WSI’s adoption of the 1997 Documentation Guidelines for Evaluation and Management Services from the Centers for Medicare & Medicaid Services (CMS) for the auditing of E&M services.
• Falsified Medical Records: This is a new policy which outlines that WSI considers any record containing non-authentic documentation as a falsified medical record.
• Physical Medicine and Rehabilitation (PM&R) Time-Based Services: This policy clarifies WSI’s adoption of the HCPCS coding requirements from The Centers for Medicare & Medicaid Services (CMS) for the evaluation of documentation and billing of time-based PM&R codes.
• A provider should review the new Documentation Policies in conjunction with WSI’s Fee Schedule Guidelines to ensure the submission of proper documentation and billing.

FEE SCHEDULE NEWS:

• The state has adopted changes to the medical and hospital fee schedules effective January 1, 2017. The next expected update is set for January 1, 2018.

FEE SCHEDULE NEWS:

• The state has adopted changes to the Physician, ASC, DME and Hospital Outpatient and ASC Surgical Facility Fee Schedules effective October 1, 2016. The next expected update is set for January 1, 2017.

REGULATORY ACTIVITY:

• WSI recently revised the First Report of Injury (FROI) form and the Online First Report of Injury (OFROI). Please use the revised form effective immediately.  Changes to the form include the following:
  • General wording changes
  • Revised section headers
  • Addition of section for additional information or comments
• WSI encourages workers and employers to file a claim online to speed up the claim registration process. When completing the online form, please use the previous and next buttons located at the bottom of the page to move through the form.