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An existing rule provides that an injured worker's physician of record or eligible treating provider must submit a medical treatment reimbursement request prior to the initiation of nonemergency treatment. The proposed rule provides a financial sanction or penalty for an unexcused failure to comply. The rule provides that medical treatment reimbursement requests submitted retroactively by the physician of record or eligible treating provider, without just cause, for nonemergency treatment delivered, rendered, or personally supervised by the physician of record or eligible treating provider must, if approved, be reimbursed at 50 percent of the applicable fee schedule amount. The physician of record or eligible treating provider may not balance bill the injured worker the difference. The proposed rule also defines the term "just cause." Providers would have the right to object to any 50 percent payment reductions through the grievance hearing procedure for disputed bill payments. In addition, the proposed rule provides that retroactive medical treatment reimbursement requests submitted within seven calendar days of the initiation of treatment or prior to the date of the physician of record or eligible treating provider's next encounter with the injured worker, whichever is earlier, is not subject to the 50 percent payment reduction.

Read more at the WorkersComp Forum homepage.

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