The New Virginia Rule 14 – Fee Schedule Soon?
The new State of Virginia Rule 14 is now closed for comments. A copy of the Proposed Rule 14 can be found here. (PDF File).
According to the Virginia Workers Compensation Commission, a public hearing on Virginia Rule 14 was held on October 13, 2015. The slides from the Rule 14 presentation can be found here. Unfortunately, the deadline for comments was October 15, 2015.
I have always been a proponent of full state fee schedules. Virginia has community rates, but not a true statewide fee schedule. A 10 community rate basis is part of the new rule. Check out the new regions in Virginia map below – (c) MC Innovations
As a side note, the Virginia Workers Compensation Commission’s webpage on medical charges is as follows:
The Act also provides the standard that is to be used in calculating reimbursement.Va. Code §65.2-605 states that the employer’s liability for medical charges is limited to “such charges as prevail in the same community for similar treatment[.]” The term “community” is defined by reference to Commission Rule 14. There is no fee schedule in Virginia. Charge schedules agreed to by the carrier and provider will be enforced.
If a dispute arises as to reimbursement for a medical charge, the health care provider may invoke one or more of the following remedies:
Adjudication Requirements
- Appropriate where there has been no payment or where provider is dissatisfied with level of reimbursement
- Initial decision issued by a deputy commissioner after reviewing evidence
- Right of review by the Commission
- Appeals to Virginia Court of Appeals and Supreme Court of Virginia
- Initiated by filing a request along with supporting evidence to the Commission
The result of no fee schedule will be further analyzed tomorrow along with a study from WCRI. Rarely do all the planets align in the WC world. This is one instance. Check back in tomorrow.
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