February 22, 2008

The following Health Care Services (HCS) rule updates for 2008 will be effective February 29, 2008 and will provide for the following:

• Rule 107 updates all source documents for coding medical services. The fee tables list only the procedure code and maximum allowable payments. The descriptors have been deleted to prevent the payment of royalty fees; therefore, it is important that providers and payers obtain the appropriate source documents to determine the accurate descriptors for the procedures.  The rule set has been updated to reflect the change from the UB-92 to the UB-04.
• Rule 504 aligns the multiple procedure policy for radiology procedures performed within families or groups of contiguous body parts as well as a multiple procedure policy for specific nuclear medicine procedures, to the standard in the health care industry.
• Rule 101003a updates reimbursement for prescribed medications using Average Wholesale Price (AWP) minus 10% and also updates the dispense fees to $3.50 for brand name drugs and $5.50 for generic drugs.
• Rule 10912 and 101003a establishes modifiers to be used with WC700 (this code is unique to MI Workers' Compensation) when billing/describing dispense fees for generic (WC700-G) and brand name (WC700-B) prescription drugs.
• Rule 10913 adopts the health care industry standard on rental status for oxygen equipment.
• Rule 101002a updates the practitioner fees by using 2007 published relative value data and a conversion factor of $50.20 (the conversion factor remains unchanged from the 2007 rule set).
• R 101023 adopts the expanded grouper rates determined by Medicare for reimbursement of freestanding surgical outpatient facility (FSOF) services.
  

You may browse, download or bookmark the 2008 HCS Rules, Manual and Fee Schedules.

2008 HCS RULES REQUIRES PROVIDERS USE NPI ON CLAIMS
AND CARRIERS/REVIEW ENTITIES MUST UPDATE EOB
(WC-739) FORMAT

• NPI:   (National Provider Identifier). This number is required on all MI Workers' Compensation claims on and after the effective date of the 2008 Health Care Services rules.  The NPI should appear in locator 33a on the CMS 1500 and FL 56 on the UB-04 (replaces the UB-92). 
• EOB FORMAT:  Carriers and their designated professional/technical review entities must use the updated WC-739 (Rev 4-07) format found on the HCS website (under the "Forms" section) with the effective date of the 2008 HCS rules.  Entities responsible for the production/distribution of MI EOB's must submit a compliant populated sample to the HCS division for approval if this has not been done.