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A review of No Fault medical provider fee schedule proposals, legislation

Here are some options based upon pending bills for No Fault medical fee schedules

medical provider fee schedule, image

Yesterday, I wrote about some of the reasons why I’ve come to support a reasonable No Fault medical provider fee schedule. I believe this may be a big part to a solution that preserves our auto No Fault insurance system in Michigan, while still protecting auto accident victims. I also believe it will eliminate much of the PIP fraud we see today, and it will allow doctors, hospitals and medical providers to get paid faster and far more efficiently without costly provider lawsuits to determine a reasonable rate.  This will remove most of the No Fault provider lawsuits that are currently clogging court dockets and case evaluations.

Today I’m sharing a review of the currently pending bills and their respective proposals for No Fault medical fee schedules:

  • House Bill 5134 (Page 6 (lines 8-14)(12/9/2015)“A hospital shall not require payment from [a Michigan No Fault auto] insurer … of more than 80% of the hospital’s charge [chargemaster rate] for inpatient, outpatient, rehabilitation, and skilled nursing facility services. This limit on payment does not apply to professional services rendered by an independent practitioner or to post-acute services provided outside of a licensed hospital facility.”
  • Senate Bill 313 (pages 1 (lines 9-10) and page 2 (lines 1-9)(5/5/2015): “A person that renders treatment … must not be reimbursed an amount that exceeds the amount the person or institution is customarily reimbursed for like products, services, and or accommodations. … A person that renders treatment … shall not seek reimbursement in an amount that exceeds the amount the person customarily is paid for rendering like treatment to injured persons for similar bodily injuries that do not arise from the ownership, operation, maintenance, or use of a motor vehicle as a motor vehicle.”
  • House Insurance Committee version of SB 248 (page 51, lines 4-10)(4/23/2015): “A person or institution that provides a product, service, or accommodation shall accept as payment in full for the product, service, or accommodation the lesser of the amount charged or 150% of the amount that would be paid under Medicare … ‘Medicare’ means Subchapter XVIII of the Social Security Act, 42 USC  1395 to 1395lll.”
  • Senate-passed version of SB 248 (page 50, lines 8-16)(4/16/2015): “The insurer or corporation … is not required to pay an amount that exceeds the average amount the person or institution customarily accepts from all sources for like products, services, and accommodations in cases not involving personal protection insurance, the program for Medical Assistance for the Medically Indigent under the Social Welfare Act, 1939 PA 280, MCL  400.1 to 400.119b, or the Federal Medicare Program established under Subchapter XVIII of the Social Security Act, 42 USC  1395 to 1395lll.”

Past No Fault medical-provider fee schedule proposals

Below are the previously introduced bills and their respective proposals for No Fault medical fee schedules:

  • Former Speaker Bolger/House GOP proposed (but not introduced) “Substitute for House Bill No. 4612” (Page 58, lines 3-11) (2/25/2014): “If an insurer pays a charge for a product, service or accommodation within 30 days after the insurer receives a billing statement for the charge, the person or institution that provided the product, service or accommodation shall accept as payment in full for the product, service or accommodation the lesser of the amount charged or 125% of the amount that would be paid under R 418.10101 to R 418.101504 of the Michigan Administrative Code or Schedules of maximum fees for Worker’s Disability Compensation developed under those rules.”
  • Senate Bill 818 (Page 35 (lines 10-20))(2/25/2014): “[A]n insurer shall pay a physician, hospital, clinic, or other person or institution lawfully rendering treatment to an injured person for an accidental bodily injury covered by personal protection insurance, or a person or institution providing rehabilitative occupational training following the injury, a reasonable amount for treatment, training, products, services, or accommodations rendered that is not more than the amount allowed for the treatment, training, products, services, or accommodations, under R 418.10101 to R 418.101503 of the Michigan Administrative Code or schedules of maximum fees for Worker’s Compensation developed under those rules.”
  • House Bill 4612 (Page 46 (lines 14-23) and page 47 (lines 1-8)) (4/23/2013): A doctor or hospital who treats a Michigan auto accident victim “may charge a reasonable amount for the products, services, and accommodations rendered” … that “shall not exceed the amount the person or institution customarily charges receives for like products, services, and accommodations in cases that do not involve personal protection insurance, the Program for Medical Assistance for the medically indigent under the Social Welfare Act, 1939 PA 280, MCL 400.1 to 400.119b, or the Federal Medicare program established under Title XVIII of the Social Security Act, 42 USC 1395 to 1395kkk-1. … If an insurer or a corporation … needs information to determine the appropriate reimbursement … the information is unavailable or not provided or the information provided is not sufficient to determine the appropriate reimbursement, the insurer or corporation shall pay the amount that would be paid under R 418.10101 to R 418.101503 of the Michigan Administrative Code or schedules of maximum fees for Worker’s Disability Compensation developed under those rules.”
  • House Bill 4936 (Page 35, lines 2-11)(9/13/2011): “A physician, hospital, clinic, or other person or institution lawfully rendering treatment to an injured person for an accidental bodily injury covered by personal protection insurance, or a person or institution providing rehabilitative occupational training following the injury, is limited to, and shall be paid by the automobile insurer at, an amount that does not exceed the amount paid for treatment, service, accommodation, and medicine under R 418.10101 to R 418.101503 of the Michigan Administrative Code or Schedules of maximum fees for Worker’s Compensation developed pursuant to those rules.”
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Blog Author Steven M. Gursten
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