Medical Fee Services eNews

Q1

2023

Virginia Workers' Compensation Commission

2022

A Year in Review

"Looking Back"

From the MFS Desk

We wanted to take a few moments to reflect on the outgoing year. In this issue, the team will highlight three best practices from our 2022 experiences to assist in promoting the best outcomes for future MFS Department submissions, highlight some of your many comments with the Commission, and share thoughts of gratefulness. I will begin by expressing gratitude to my team, Ashley, Chris, and Hope, for their work and efforts in providing strong customer service and propelling the “Dream Team” forward with their responsiveness to external and internal stakeholders.

In closing, there are two key activities already underway for 2023. The Commission and the Regulatory Advisory Panel meetings to review the schedules have begun for the new schedules to be effective January 1, 2024. The Commission will host the first Medical Fee Services Symposium during the VWC Education Conference this year (save the date, October 18-19, 2023). We are excited to invite our stakeholders to this event. Please continue to review the Commission website for your source for updates and information regarding these and other Commission events

Happy New Year

-Dr. Drema Thompson

Best Practices

Medical Fee Dispute Document Submissions/Avoiding Delays

How to Avoid Delays in Dispute Processing

1. Ensure dispute form submission is complete.

2. Provide legible supporting documentation.

1. Explanation of reviews
   
2. Medical records
   

Properly Filled Out Claim Form

1

2a. Easy to Read Explanation of Review

2b. Unreadable Medical Record

Submit Appropriate Medical Dispute Billing and Coding

• Provider Specialty Category (taxonomy code are used to define the area of specialty)
• Companion Bill
• Surgeon’s bill for an assistant medical fee disputes
  

Surgeon's Billing (Companion Bill)

Taxonomy Code

Assistant at Surgery Billing

Submitting Disputes Requesting Review for Traumatic Injury Exclusion

• Assigned a DRG Number
  
• Inpatient stay = 23 hours
  
• A hospital in the Commonwealth designated by the Board of Health as a Level I or Level II trauma center pursuant to the Statewide Emergency Medical Services Plan developed in accordance with § 32.1-111.3.
  
• Professional and facility services associated with traumatic injuries are MFS exclusions.
  

Traumatic Injury

"TRAUMATIC INJURY" means an injury for which admission or transfer to a Level I or Level II trauma center (see “Level I or Level II Trauma Center”) is medically necessary, and that is assigned a DRG number of 003, 004, 011, 012, 013, 025 through 029, 082, 085, 453, 454, 455, 459, 460, 463, 464, 465, 474, 475, 483, 500, 507, 510, 515, 516, 570, 856, 857, 862, 901, 904, 907, 908, 955 through 959, 963, 998, 999.

Operative Note

The type of procedures performed by this service are highly complex and sub-specialized in nature. Therefore the use of a highly trained physician assistant was medically necessary in this case and would be considered standard of care to maximize patient result and minimize patient anesthesia.

Thank you, Christopher; I will save this info for any in the future as well.

THANK YOU

Good Morning; I will thank you for the information provided.

clarification

Thank you for this response

quick response!

THANK YOU GREATLY!

Thank you for your

assistance!

Thank you again! Hope and Chris are amazing.

Thank you for the clarification.

Thank you so much, Hope! I appreciate the information.

Thank you for your quick response!

AMAZING

Customer Satisfaction

“2022” gave me many things to be grateful for; I am thankful for good health, family, friends, and

the opportunity to experience the many joys of life. I hope that 2023 brings more of the same

positivity. Happy New Year to all!”

Chris, Medical Fee Services Analyst

“2022” reminded me to focus on the basics of life: forgiveness, courage, love, and humor. By

this standard, I am eternally grateful for the small steps I achieve each day and will move forward

exercising compassion for all walks of life

Ashley, Medical Fee Compliance Analyst

“2022” presented tremendous opportunities to exercise my faith in many situations. It taught me to keep things in perspective, take life one day at a time, and find a way to be thankful and joyful in every situation and give, give, give! -Hope, Medical Fee Services, Analyst

"What are you grateful for today?"

Do you have new staff?

Would you like an overview of the medical fee schedules?

Please send your request to: medicalfeeservices@workcomp.virginia.gov