FW: Notice of publication of temporary Oregon Medical Fee and Payment Rules

[Guest guest]

F.Y.I.,

As per the latest Rules Advisory committee meetings on fees and MCO

contracted fee levels and how they pertain to panel providers.

Vern Saboe

Notice of publication of temporary " Oregon Medical Fee andPayment

Rules "

To:

Knight, SAIF Corporation

Bobbi Nasal, Coventry/First Health

Kreutz, AAL, Radler Bohy & Replogle LLP

Darrell DeMoss, MedRisk - Medical Risk Management Inc.

Godwin, Representing Physical Therapists

Dolores , CareMark Comp

Evan Karp, Oregon Health Systems, Inc.

, Corvel Corporation

Tsang, MD, Salem Occupational Health Clinic

Bronder, Universal Smart Comp

Janet son, Ph.D., Universal Smart Comp

Flood, Ombudsman for Injured Workers

R. Braddock MD, Cascade Occupational Medicine

Kathy Loretz, SAIF Corporation

Laurel Gunderson, Providence MCO

Lon Holston, Management-Labor Advisory Committee

Keating, Liberty Northwest Insurance

Simms, Cascade Occupational Medicine

Michele M. Oatman, Coventry/First Health

Niemeyer, Kaiser-on-the-Job

Medalia, Corvel Corporation

Brown, RN Liberty Northwest Insurance

Rich Katz, Therapeutic Associates

Ron Grant, Corvel Corporation

Gallant, Oregon Medical Association

Sheila Hansen, Corvel Corporation

Sheri Sundstrom, Management-Labor Advisory Committee

Lavier, City County Insurance Services

Velda , Kaiser-on-the-Job

Vicky Hoch, Corvel Corporation

Wanda Pilakowski, Kaiser-on-the-Job

" Chip " Bartel, Special Districts Association of Oregon

Dear committee members:

Thank you for again for your participation at our meeting of June 27. The

department has decided to proceed with temporary rules that allow insurers

to reimburse at a contracted rate when the provider has entered into a

contract with a provider network. The rules are effective today, July 7,

2008. I have attached a copy of the rules, and these are also on our Web

site: http://wcd.oregon.gov/policy/rules/rules.html

The committee's advice has been crucial to the development of some

safeguards. We heard that sometimes multiple discounts are applied, e.g. ((N

minus 15%) minus 15%), that PPO discounts have been applied to an MCO panel

member for services to workers enrolled in an MCO, and that some providers

cannot obtain copies of the contracts that affect payment for medical

services. These temporary rules:

Allow only one contract to be applied to a providers' bill;

Specify that when a worker is enrolled in a managed care organization (MCO),

the MCO contract rate must be applied;

Specify that insurers must tell providers that they have 90 days to request

administrative review of a dispute of the reimbursed amount; and

Require the insurer to produce the contract under which a fee was paid upon

request of the director or the provider.

We appreciate your contributions of time and knowledge to this process.

Because a temporary rule can be in effect no more than 180 days, we will now

open these rules for public rulemaking and invite the committee to

reconvene, probably in August or September.

I do not have e-mail addresses for all who attended, especially those on

teleconference. If you see names above that are not copied with this

message, please forward this message to them.

Please contact me if you have questions or if I may assist in any way.

Sincerely,

Fred Bruyns, rules coordinator

Oregon Workers' Compensation Division

Policy & Communications Section

(503) 947-7717 fax (503) 947-7581

fred.h.bruyns@...