Virginia Workers' Compensation Commission

Medical Fee Services Newsletter

Q1 2024

Regulatory Focus - 65.2-605.D

The Virginia Workers’ Compensation 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

What a year in 2023! As I reflect on the outgoing year, in a word, this was a year of several “first” initiatives for the ​Medical Fee Services Department in the completion of its core responsibilities:

(a) administration of the Medical Fee Schedule,

(b) responding to Medical Fee Schedule inquiries, and

(c) education and training for the public.

Effective with the new 2024 schedules, the first MFS Calculator was released. In response to stakeholder inquiries, the ​first MFS Training Module which includes a six-session series covering all things MFS was released. In our efforts to ​identify opportunities to expand our Education and Outreach, the MFS “Dream Team” completed the inaugural launch ​of the MFS Symposium during the opening day of the VWC Educational Conference & Exhibition. Ashley, Chris, and ​Hope, (MFS Dream Team) thank you for your hard work in the delivery of these initiatives.

In closing, this issue also highlights key user best practices for the New MFS Calculator and upcoming events for 2024. ​Please continue to review the Commission website as your first source for updates and information regarding these ​events and other Commission news.

Happy New Year,

Dr. Drema Thompson

Medical Fee Services Manager

The MFS Calculator

The MFS Calculator has replaced the MFS Reference Tool. The MFS Calculator is a convenient resource that ​determines regional classifications and maximum rates of payments, incorporating applicable Ground Rules ​adjustments at the bill level to return the combined fee scheduled maximum assigned amount.

See additional information below on the new features, user best practices for this new Commission resource and ​important event dates listed.

NEW! The MFS Calculator includes:

• A list of applicable provider categories based on the billing code.
  

• The ability to allow users to edit and remove values.
  

• Data that can be exported out of the calculator into Microsoft Excel.
  

• The ability to enter multiple modifiers and receive an adjusted maximum fee based on an appropriate Ground ​Rules adjustment.
  

• The ability to identify the lesser of logic and modify the resulting maximum fee.
  

NEW: MFS Calculator Tutorial

MFS Calculator Best Practices

The MFS Calculator is a tool intended to assist in the application and understanding of the Medical Fee ​Schedules and ​the Ground Rules document, located here.

For a complete listing of helpful hints and best practices, please visit the MFS Calculator Reference Manual. Here are ​a few best practices:

Tip 1. What should be entered if the JCN is unknown:

The MFS Calculator requires the entry of the JCN or an entry of up to 12 alpha/numeric characters in ​this field to create a new bill.

Tip 2. The incorrect zip code or JCN was entered. How to edit these values:

Once the zip code and JCN fields are entered and the “Create Bill” button is depressed, the calculator ​will not allow further edits. Depress the “Clear Bill” button to start over.

Tip 3. The calculator returned a successful result but the data shows N/A:

The data from the calculator comes directly from the Medical Fee Schedule. Type-One teaching ​hospitals exist only in regions 2 and 3 and have assigned fees for applicable billing codes. Therefore, if ​your region of service is in any region other than 2 or 3, or the billing code is not applicable, and you ​select a Type-One teaching hospital, the result will be N/A as it is a legitimate value in the fee schedule.

Helpful Links

MFS Symposium

Thank you to those who attended the 2023 MFS Symposium. We have received and appreciate your feedback ​including the submission of possible topics and speakers for future events!

Save the date for the 2024 MFS Symposium, again held during the first day of the Virginia Workers’ Compensation ​​Commission’s Educational Conference on October 8, 2024. More details coming soon.

MFS Training Opportunities

Topics below are available in-person or virtually.

Understanding the Nuts and Bolts of the Medical Fee Schedules

• Provides a comprehensive review of the MFS Regulations
  
• Introduces the roles and responsibilities of the Commission and Regulatory Advisory Panel
  
• Explores key MFS schedule data elements
  
• Explains the role of the Ground Rules
  

Impacts and Influences of the Medical Fee Schedules

• Clarifies implications for Providers and Payers
  
• Illustrates the MFS review and maintenance of schedules
  

Medical Fee Schedule Dispute Resolution

• Reviews forms and notices
  
• Gives examples of required documentation
  
• Provides examples of key applicable coding conventions
  
• Discusses MFS exclusions and dispute resolution
  

Breaking down the Administrative Determination

• Reviews the importance of supporting medical records
  
• Explores the administrative decision components
  
• Discusses the process to appeal the decision
  

Medical Provider Inquiry Forms

• Reviews the importance of supporting medical records
  
• Explores the administrative decision components
  
• Discusses the process to appeal the decision
  

Ways to Contact MFS

Contact the Medical Fee Services Department toll-free at 877-664-2566.

Below are recommendations for the best ways to contact MFS depending on your need.