Texas Medical and Hospital Fee Guideline Rules Updated

Texas Commissioner of Workers’ Compensation Albert Betts signed rules to update a medical fee guideline for health care providers, to establish a hospital outpatient fee guideline and to update a hospital inpatient fee guideline for the Texas workers’ compensation system, the Texas Department of Insurance announced.

The medical fee guideline rules relate to professional service reimbursements to health care providers who provide medical treatments and services to injured employees on or after March 1, 2008. The outpatient and inpatient hospital fee guidelines rules apply to inpatient admissions and outpatient dates of service for injured employees on or after March 1, 2008.

The medical fee guideline and outpatient and inpatient hospital fee guidelines use the Medicare system as a framework for billing and reimbursement methods in the workers’ compensation system. The guidelines establish standardized formats for billing and reimbursement as used in group health and Medicare systems.

Also, the medical fee guideline establishes new incentive payments to health care providers caring for injured employees in areas of the state designated as underserved by Commissioner Betts.

The medical fee guideline and outpatient and inpatient hospital fee guidelines rules are posted on the agency Web site at: www.tdi.state.tx.us/wc/rules/adopted/adopted.html.