<< All News Friday, January 29, 2016 - 08:00am Categories:<< All News
Medical Provider News Archive
Effective January 1, 2016, WSI implemented the following fee schedule changes.
- Ambulance fee schedule update is based on the CPI-U
- Reimbursement increased by 0.1%
- Ambulatory Surgery Center fee schedule update is the Market Basket for hospital services
- ASCs billing for device-intensive procedures
- Report a single line item charge that includes both the charges associated with the service and the implantable device.
- WSI will reimburse for services in the Medicine Section of the AMA CPT® code set if listed on Medicare’s published list of covered ASC services.
- Conversion factor increased by 2.4% to $102.72
- Anesthesia fee schedule
- Conversion factor increased 1.1% to $57.25
- Clinical Laboratory fee schedule is 250% of North Dakota’s Medicare Laboratory fee schedule
- Dental fee schedule reflects a consistent payment for providers in all locations
- Usual & Customary (UCR) module at the 70th percentile will be used
- Durable Medical Equipment fee schedule is 120% of North Dakota’s Medicare schedule
- Home Health Care fee schedule update is the Market Basket for Home Health services
- Increase is 2.3% rounded to the nearest 50 cents
- Inpatient Hospital fee schedule update is a blended (operating and capital) Market Basket increases for hospital services with adjustments for anticipated DRG weight and coding changes
- Market Basket base rate increased by 2.3% to $8,910.00
- The outlier threshold for 2016 is $61,500
- Medicine fee schedule uses the Resource Based Relative Values System (RBRVS) Relative Value Unit (RVU) established by CMS. All services have a single conversion factor
- Includes fee schedules for Chiropractic, E&M, Pathology, Medicine, PT and OT, Radiology and Surgery codes
- CPT code changes from the American Medical Association (AMA) have been adopted
- In following Medicare’s requirements, WSI will not recognize consult codes as valid codes.
- Conversion factor increased by 1.1% to $67.12
- Outpatient Hospital fee schedule update is the Market Basket for hospital services
- Conversion factor increased by 2.4% to $130.18