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 25.091, 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, 2001. 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)564-5550, Ext. 488. Enclosure
Effective April 1,2001 FACILITY NAME 2001 COST TO CHARGE RATIO Baptist East 67.4204% Baptist Regional 63.1282% Berea 78.0323% Bourbon Community 62.1460% Breckinridge Memorial 65.8676% Caldwell County 62.4602% Cardinal Hill Rehabilitation 55.7186% Caritas Medical 52.3913% Carroll County Memorial 62.3728% Casey County 85.0000% Caverna Memorial 68.1323% Central Baptist 62.4005% Clark Regional Medical 61.3371% Clinton County 64.1854% Crittenden County 74.1901% Cumberland County 72.3101% Ephraim McDowell 63.3335% Flaget Memorial 58.2947% Fleming County 67.8510% Fort Logan 72.8199% Frankfort Regional Med Ctr 49.4192% Garrard County Memorial 80.2525% Georgetown Community 60.8031% Greenview Reg. Hosp. 46.6671% Hardin Memorial 62.0282% Harlan ARH 61.4340% Harrison Memorial 62.4220% Hazard ARH 61.7290% Healthsouth Northern KY 53.3552% Rehab Healthsouth Rehab of 49.2385% Central KY Highland Regional Med 51.8562%
James B. Haggin Mem. 71.9009% Jane Todd Crawford Mem 70.0050% Hosp. Jenkins Community 52.7986% Jennie Stuart Medical 60.3600% Jewish Inc. 52.1437% Jewish Shelbyville 46.9970% Kings Daughters Medical 67.9858% Knox County 60.5200% KY River Med 46.9246% Lake Cumberland Regional 35.6068% Livingston County 73.3179% Logan Memorial Hosp. 63.8740% Lourdes, Inc. 65.8942% Marcum & Wallace 72.1923% Memorial Hosp. Marshall County 80.7673% Mary Breckenridge 74.8947% Mary Chiles 61.2370% Marymount Medical 64.3712% McDowell ARH 66.8090% Meadowview Regional 46.8891% Mediplex Rehab ( Bowling 58.1065% Green) Memorial, Inc. 56.7167% Methodist 72.6126% Middlesboro ARH 59.1050% Monroe County Medical 71.8797% Morgan County ARH 61.7387% Muhlenberg Community 70.2323% Murray-Calloway Co. 80.1519% Nicholas Co. 78.1034% NKC, Inc. 60.6009% Norton Audubon 47.0646% Norton Southwest 53.3579% Norton Springview 60.2419%
Norton Suburban 46.6978% Ohio County 74.1070% Our Lady of Bellefonte 55.2616% Our Lady of the Way 70.2604% Owen Co. Memorial 51.8125%, Inc. Owensboro Mercy Health 63.0500% System Parkway Regional 56.3270% Pattie Clay 62.8998% Paul B. Hall Regional 35.1830% Pikeville Methodist 59.7551% Pinelake Regional 64.0128% Pineville Community 73.4627% Regional Medical 62.6012% Rockcastle & 61.1710% Resp. Care Russell County 69.1614% Samaritan 64.2071% St Elizabeth Grant Co. 65.9605% St Luke East 69.8978% St. Claire Medical 72.7213% St. Elizabeth Medical 64.0986% St. Joseph East 53.2283% St. Joseph 53.5515% St. Luke West 68.4876% T.J. Samson Community 75.0961% Taylor County 66.0538% The Medical 59.6565% (BG/Scottsville) The Medical at 75.1605% Franklin Three Rivers Medical 48.0472% Tri County Baptist 71.3395% Trigg Co. 80.4948% Twin Lakes Regional 60.5821% Medical UK 78.5540% Union County Methodist 66.2384%
University of Lousiville 54.4277% Vencor 43.9001% Wayne County 69.3527% Western Baptist 64.2021% Westlake Regional 69.2747% Whitesburg ARH 60.5810% Williamson ARH 57.1460% Woodford County Memorial 74.8970%