Whitt & Del Bueno, Attorneys at Law

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Legislative Amendments Effective July 1, 2014

By Mike Del Bueno

There are some noteworthy workers’ compensation legislative amendments that take effect July 1, 2014 that deal with medical provider treatment and costs. All of the below information deals with medical treatment rendered subsequent to July 1, 2014.

When a nurse practitioner or physician assistant serves as an assistant during surgery, the employer and carrier are liable, at most, to twenty percent of the reimbursement due to the physician performing the surgery. Additionally, for an assistant surgeon in the same specialty as the primary surgeon, the employer and carrier are liable, at most, to fifty percent of the reimbursement due to the physician performing the surgery. Furthermore, when multiple procedures are performed during a single surgery, those are to be coded and billed with appropriate CPT modifiers and paid according to NCCI rules and the CPT in effect at the time the surgery is performed. These three amendments are within section 65.2-605 of the Code of Virginia.

Section 65.2-605.1 is a new addition. That new code section provides, among other things, that in regard to medical treatment that the employer and carrier do not contest, deny or consider incomplete, the employer and carrier must pay for such treatment within sixty days of receipt of each separate itemization of medical services provided. Additionally, if the itemization or a portion of it is contested, denied or considered incomplete, then the employer or carrier shall notify the medical provider of the same within forty-five days after receipt of the itemization. Furthermore, payment due for any properly documented medical provider services that are not contested within the forty-five day period nor paid within the sixty day period shall be increased by interest at the judgment rate of interest retroactive to the date payment was due.

Another notable aspect to section 65.2-605.1 is a statute of limitations on medical provider claims filed with the Virginia Workers’ Compensation Commission. A medical provider may not file such a claim with the Commission unless it is done within one year of the date the last payment is received by the medical provider or, if the employer and carrier denied or contested payment for any portion of the medical services, then, for that service, the claim must be filed within one year of the date the medical award covering such date of service for specific treatment in question becomes final.

It seems likely that these amendments may cause some issues with claims you may be involved with in regard to medical treatment rendered after July 1, 2014. If you have any questions in these regards, please feel free to contact our firm for assistance.