URGENT!!! Important changes to workers compensation fee schedule – Jan 2015

Posted on November 17, 2014 by Chapter Staff
Originally Published in HAPTA’s e-Newsletter, What’s HAPTAnin’ – November 2014

URGENT!
Needs your attention

Physical therapy CPT codes under the State of Hawaii Workers Compensation system will be reduced by an average of 7.2%. Please either write, be present to testify or support. Worker’s compensation constitutes a large portion of the income of many practices. This change can ripple across to other payors to justify reducing their fee schedule. It has happened in the past. There will be a public hearing at the Department of Labor on November 20 at 8:30 AM. Written testimony can be submitted up to the day of the hearing. I understand this is short notice; it has taken us this long to confirm this is really happening. Some areas are still hazy.

Background: The Department of Labor and Industrial Relations (DLIR) administers the fee schedule of charges for treating patients under the Worker’s Compensation system. The fees, unless exempted by the Director is based on Medicare rates plus 10 percent. Historically this has been problematic as Congress annually threatens to reduce Medicare rates under the Balanced Budget Act. Last year, the Director separated most of the CPT codes used by PT’s along with others from this and increased their value an average of about 7%.

In this year’s proposal there is a return of these codes to the previous Medicare plus ten percent system. This would reduce the present values an average of 7.2% below that of 2014 values. Given the changes to cost of living this or any reduction is unacceptable. Attached is; 1) a copy of the testimony on behalf of the Chapter, 2) another shell testimony drafted by Patti Taira-Tokuuke, 3) the Notice of hearing from the Department of Labor, 4) a breakdown of proposed changes, 5) Auditors Reports. If you’re interested on more details. Feel free to copy and adapt to personalize either testimony. Individualized letters would also be of help in our arguments. We are planning on being at the hearing.

Other points that have been brought up on evaluating the fees in the past include;

  • Hawaii ranks 37 lowest out of 43 states using CPT codes in Work comp fees,
  • Aligning fees with third party payors (HMSA, Kaiser, etc.) is illogical;
    • most third party payers do not require visit notes to get paid or to even start PT,
    • with some third party payers, they do not require a MD prescription (Medicare being one of them)
    • all 3rdparty payers (except for QUEST Plans) have co-payments, co-insurances and/or deductibles,
    • if filing electronically for third party payers, we can usually get paid on a clean claim in 7 days versus workers comp payers, up to 60 days,
    • if an employer (insurer) decides to contest a claim, it could take months to get paid, some claims take almost 1 year to resolve,
    • worker’s comp require more paper “pushing” with treatment plans, watching approvals, dates, mailing documentation, awaiting hearing results to proceed
    • most 3rdparty payers have “benefit limits” for therapy services and state in their policies that PT is “short term”, versus in a workers comp case we need to get patients back to full duty full time work

Special thanks to Patti Taira-Tokuuke, Derrick Ishihara and others for all your work on this thus far. The work is far from done. We’ll keep you posted on the results. Please contact us if you would like to assist.

To submit written testimony:

  • Open either the HAPTA testimony or the shell attached, feel free to compose your own if you’ve a different point of view,
  • Print 5 copies (letterhead is a nice touch)
  • Mail or drop off up to the day of the hearing November 20,

Director Dwight Takamine
Department of Labor and Industrial Relations
Disability Compensation Division
830 Punchbowl Street, Room 209
Honolulu, HI 96813

To present oral testimony:

When: November 20, 2014, 8:30 a.m.
Where: Keelikolani Building
830 Punchbowl Street
Rooms 310, 313, and 314
Honolulu, Hawaii 96813

Herbert Yee
HAPTA President

Attachments:

1) Testimony
2) Nov 2014 DLIR Hearing Testimony Shell Testimony
3) Department of Labor Notice – 11-20-14-PH-MFS 
4) 2015 Proposed WC Fees
5) Work Comp State Auditor Report
6) Small Business Impact Statement 20140916

 

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