Medical Fee Services eNews
Q4
2023
Virginia Workers' Compensation Commission
Regulatory Focus
65.2-605 D The Commission shall review Virginia fee schedules during the year that follows the transition date and biennially thereafter and, if necessary, adjust the Virginia fee schedules in order to address (i) inflation or deflation as reflected in the medical care component of the Consumer Price Index for All Urban Consumers (CPI-U) for the South as published by the Bureau of Labor Statistics of the U.S. Department of Labor; (ii) access to fee scheduled medical services; (iii) errors in calculations made in preparing the Virginia fee schedules; and (iv) incentives for providers. The Commission shall not adjust a Virginia fee schedule in a manner that reduces fees on an existing schedule unless such a reduction is based on deflation or a finding by the Commission that advances in technology or errors in calculations made in preparing the Virginia fee schedules justify a reduction in fees.
Greetings from the Manager
In this issue, we will highlight some key initiatives underway for the remainder of 2023 and the upcoming year. The Commission has completed the MFS Biennial review in accordance with 65.2-605 (D). The 2024 Medical Fee Schedule and Ground Rules become effective on January 1, 2024. For a complete listing of updates, please review the summary document here.
The below lists some of the key revisions made to the existing schedule:
Update for Medical Inflation
Definitions were added for “Fixed Amount Per Service” and “Fixed Amount Per Unit.”
Payment rules were added for modifier AD
Effective in 2024, the Commission will release the MFS Calculator. The MFS Calculator will replace the current MFS Reference Tool. The calculator will determine regional classifications and maximum rates of payments and incorporate many of the applicable Ground Rules adjustments at the bill level to return the combined fee schedule maximum assigned amount.
The Commission will also host the first Medical Fee Services Symposium on October 18, 2023, from 9:00 a.m. to 12:00 p.m. at the Richmond Convention Center. The MFS Symposium is a stand-alone free event that is separate from the Annual VWC Education Conference. Registrants for the conference are welcome to attend. This will be an information-packed event featuring a wide range of topics and speakers representing varied workers’ compensation stakeholder knowledge and experiences.
The MFS Symposium will benefit all who have an interest in the Virginia workers' compensation system's Medical Fee Schedule, current rules, procedures, policies, and forms and will provide an opportunity for dialogue among these participants.
Additionally, attendees have a chance to engage with members of the Regulatory Advisory Panel, a core group of stakeholder representatives integral to the Commission’s biennial review activities for the medical fee schedules. For additional information and to register, please visit the MFS Symposium site. We invite you to come and join the conversation.
October 18, 2023
Training Opportunities
Topics below are available in person or virtually.
Understanding the Nuts and Bolts of the Medical Fee Schedules
- Provide a comprehensive review of the MFS Regulations
- Introduce the Roles and responsibilities of the Commission and Regulatory Advisory Panel
- Explore key MFS schedule data elements
- Explain the role of The Ground Rules
Impacts and Influences of the Medical Fee Schedules
- Clarify Implications for Providers and Payers
- Illustrate the MFS review and maintenance of schedules
Medical Fee Schedule Dispute Resolution
- Review Forms and Notices
- Give examples of required documentation
- Provide examples of key applicable coding conventions
- Discuss MFS Exclusions and dispute resolution
Breaking down the Administrative Determination
- Review the importance of supporting medical records
- Explore the administrative decision components
- Discuss the process to appeal the decision
Medical Provider Inquiry Forms
- Review the importance of supporting medical records
- Explore the administrative decision components
- Discuss the process to appeal the decision
Are you interested in one of the above trainings or an overview of the medical fee schedules?
Email us here.
