Louisiana Workers Compensation Update: Still having to pinch pennies

Louisiana hospitals have been forced to devote a lot of time and energy to Workers
Compensation claims because of the recent years decline in reimbursement.  Carriers and audit
companies have located loopholes in the rules allowing them to pick and choose payment
methodologies. Unfortunately, some of their payment methodologies are not even from verfiable
sources such as Medicare, Medicaid, and Federal OWCP!

To help correct the problem, the LHA Provider Advisory Committee has prepared a suggested Fee
Schedule that will be presented to the Louisiana Office of Workers Compensation. The proposal
includes reducing the 90%-of-charges allowable on outpatient claims as well as clarification on
allowables for inpatient claims.  The challenges Louisiana hospitals face today is the vague
wording in the current rules allowing carriers to determine their own usual and customary
reimbursement. With the rise of secondary audit companies such as Qmetrix, the reimbursement
on outpatient claims is steadily dropping. The challenge for hospitals is not being able to
calculate at the time of billing what they were actually going to be paid.  The range is somewhere
between less-than-Medicare and 90% of charges!  Same problem with outlier claims.  Though a
claim may have "financially" qualified, if the argument could not be made that the claim is atypical
in nature, you did not receive additional reimbursement.  The challenges then became 1) What is
the definition of "atypical"?,  and 2) The outlier determination was at the discretion of the ONE
person reviewing your claim. Hopefully, there will be a successful negotiation on the development
of a new fee schedule that is at least closer to a win-win.

For more information, contact Angie Box at (817) 200-2820, ext. 206