All Insurance Carriers, Self-Insured Employers, Group Self-Insureds, Regulated Facilities and Medical Bill Vendors FROM:

Transcription

1 TO: FROM: All Insurance Carriers, Self-Insured Employers, Group Self-Insureds, Regulated Facilities and Medical Bill Vendors WALTER W. TURNER, COMMISSIONER Department of Workers Claims DATE: March 22, 2001 SUBJECT: 803 KAR 25:091 ( Fee Schedule) Pursuant to authority granted the Commissioner by 803 KAR , a schedule of fees for reimbursement for medical services provided by hospitals was developed. This regulation requires the Department of Workers Claims to calculate each hospital s adjusted cost-to-charge ratio each calendar year. Enclosed is a copy of the revised master list of adjusted cost-to-charge ratios for facilities governed by the hospital fee schedule. The revision applies to all hospital bills submitted for services rendered on or after April 1, The revision includes a twelve percent (12%) return to equity add on and appropriate adjustment for disproportionate share providers as defined by 803 KAR 25:091, Section 3. No additional adjustments should be made to the enclosed list of cost-to-charge ratios. The figure set forth beside each facility s name represents the ratio to be used to adjust the hospital billing pursuant to 803 KAR 25:091. To apply the hospital fee schedule, the UB-92 billing form should be reviewed to ensure that all the charges arise from treatment of a compensable injury and reflect the usual and customary charges for the services performed by the facility. Once that has been done, the amount billed is multiplied by the facility s adjusted cost-to-charge ratio. This yields the amount due from the carrier or self-insured employer. If you have any questions or concerns, please contact staff attorney Donna Elsen Floyd at (502) , Ext Enclosure

2 Effective April 1,2001 FACILITY NAME 2001 COST TO CHARGE RATIO Baptist East % Baptist Regional % Berea % Bourbon Community % Breckinridge Memorial % Caldwell County % Cardinal Hill Rehabilitation % Caritas Medical % Carroll County Memorial % Casey County % Caverna Memorial % Central Baptist % Clark Regional Medical % Clinton County % Crittenden County % Cumberland County % Ephraim McDowell % Flaget Memorial % Fleming County % Fort Logan % Frankfort Regional Med Ctr % Garrard County Memorial % Georgetown Community % Greenview Reg. Hosp % Hardin Memorial % Harlan ARH % Harrison Memorial % Hazard ARH % Healthsouth Northern KY % Rehab Healthsouth Rehab of % Central KY Highland Regional Med %

3 James B. Haggin Mem % Jane Todd Crawford Mem % Hosp. Jenkins Community % Jennie Stuart Medical % Jewish Inc % Jewish Shelbyville % Kings Daughters Medical % Knox County % KY River Med % Lake Cumberland Regional % Livingston County % Logan Memorial Hosp % Lourdes, Inc % Marcum & Wallace % Memorial Hosp. Marshall County % Mary Breckenridge % Mary Chiles % Marymount Medical % McDowell ARH % Meadowview Regional % Mediplex Rehab ( Bowling % Green) Memorial, Inc % Methodist % Middlesboro ARH % Monroe County Medical % Morgan County ARH % Muhlenberg Community % Murray-Calloway Co % Nicholas Co % NKC, Inc % Norton Audubon % Norton Southwest % Norton Springview %

4 Norton Suburban % Ohio County % Our Lady of Bellefonte % Our Lady of the Way % Owen Co. Memorial %, Inc. Owensboro Mercy Health % System Parkway Regional % Pattie Clay % Paul B. Hall Regional % Pikeville Methodist % Pinelake Regional % Pineville Community % Regional Medical % Rockcastle & % Resp. Care Russell County % Samaritan % St Elizabeth Grant Co % St Luke East % St. Claire Medical % St. Elizabeth Medical % St. Joseph East % St. Joseph % St. Luke West % T.J. Samson Community % Taylor County % The Medical % (BG/Scottsville) The Medical at % Franklin Three Rivers Medical % Tri County Baptist % Trigg Co % Twin Lakes Regional % Medical UK % Union County Methodist %

5 University of Lousiville % Vencor % Wayne County % Western Baptist % Westlake Regional % Whitesburg ARH % Williamson ARH % Woodford County Memorial %