2009 Workers' Compensation Medical Symposium materials

In April 2009, the Department of Labor and Industry had three medical symposiums to discuss medical bill submission, review, payment and dispute resolution in light of the Buck-Ulrick and Lehto decisions.

The discussion included:

the health care provider's obligations for billing;
the new electronic transaction rules;
the payer's responsibilities upon receipt of the bills from the health care provider;
bases for adjusting the bills;
current legal "hot topics" surrounding this process, including implant charges, prevailing charges, bundling and other bill review principles used by payers;
current case law, including Buck-Ulrick and Lehto;
how to get help from the department for medical billing issues;
medical requests/alternative dispute-resolution for medical billing issues; and
penalties associated with medical benefits.

The following PDF files contain the PowerPoint presentations and some of the materials related to the symposiums.

Symposium materials

Topic Presentation Additional materials

Medical bills: Your responsibilities under the rules and current issues about processing payments Presentation Fee schedule materials

WCCA cases about surgical implants and prevailing charge Presentation Buck-Ulrick and Lehto decisions

Electronic billing transaction Presentation Electronic billing materials

Penalties for failure to properly pay or deny medical bills Presentation Relevant penalty statutes and rules

A dispute-resolution hierarchy Presentation Handouts; Medical Request form and filing instructions

Mediation for health care disputes Presentation DLI mediator composite resume; DLI mediation brochure

Symposium materials
Topic	Presentation	Additional materials
Medical bills: Your responsibilities under the rules and current issues about processing payments	Presentation	Fee schedule materials
WCCA cases about surgical implants and prevailing charge	Presentation	Buck-Ulrick and Lehto decisions
Electronic billing transaction	Presentation	Electronic billing materials
Penalties for failure to properly pay or deny medical bills	Presentation	Relevant penalty statutes and rules
A dispute-resolution hierarchy	Presentation	Handouts; Medical Request form and filing instructions
Mediation for health care disputes	Presentation	DLI mediator composite resume; DLI mediation brochure