October 28, 2015

Maine Workers' Compensation Alert: Board Revises Fee Schedule and Changes Reimbursement Rules

The Maine Workers’ Compensation Board has published a new Medical Fee Rule and made revisions to rules regarding reimbursement and expense payments, effective October 1, 2015. The following are some key changes:

New Medical Authorization

In the event that an employer/insurer seeks an injured employee’s medical records, the following limited authorization must be obtained from the employee. The release is also intended to be used to obtain medical records relating to an employee’s pre-existing and subsequent non work-related conditions. An employee must return the form to the requesting employer/insurer within 14 days. This is the only valid medical release that can be used. The authorization is attached here.

Changes to Reimbursement Rules

There are several significant changes for dates of service on or after October 1, 2015:

  • Payors must be able to process claims with either ICD-9 or ICD-10 code sets.
  • An employer/insurer can enter into payment agreements with providers:
  1. A written payment agreement between a health care provider and employer/insurer supersedes the maximum allowable payment otherwise available;
  2. A written payment agreement between a health care provider and entity other than the employer/insurer seeking to invoke its terms supersedes the maximum allowable payment otherwise available under this chapter only if the employer/insurer was a named beneficiary of the payment agreement at the time the health care provider signed the payment agreement.
  3. An employee retains the right to select health care providers for the treatment of an injury or disease for which compensation is claimed regardless of any payment agreement.
  • Health care providers may charge for completing an initial diagnostic medical report (Form M-1) or other supplemental report. The maximum fee for completing an initial M-1 form or other supplemental report is $30.00 per 10 minutes.
  • Health care providers may charge for copies of the health care records required to accompany the bill. The maximum fee for copies is now $5 for the first page and 45¢ for each additional page, up to a maximum of $250.00.

Changes to Rules Regarding Expense Payments

  • Reimbursable travel-related expenses now includes travel to the pharmacy;
  • The employer/insurer must pay the employee’s travel-related expenses within 30 days of receipt of a request for reimbursement. Out-of-pocket costs for medicines and other non-travel-related expenses must be paid within 30 days of a request for reimbursement accompanied by receipts.

To facilitate the payment of employee expenses, the Board has developed a new form which you can view here.

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