El Paso Functional Medicine
I hope you have enjoyed our blog posts on various health, nutritional and injury related topics. Please don't hesitate in calling us or myself if you have questions when the need to seek care arises. Call the office or myself. Office 915-850-0900 - Cell 915-540-8444 Great Regards. Dr. J

Annual Change To Medical Fee & Health Care Reimbursement

706

Workers’ Compensation System Participants

Annual Change to the Medical Fee Guideline Conversion Factors as Established in Title 28 Texas Administrative Code (TAC) §134.203

The purpose of this bulletin is to inform workers’ compensation system participants of the annual change to the Medical Fee Guideline conversion factors as established in 28 TAC §134.203.  Under Labor Code §413.011(a), fee guidelines adopted by the Division of Workers’ Compensation (DWC) for non-network services and approved out-of-network services are based on the most current reimbursement methodologies, models, and values or weights used by the federal Centers for Medicare and Medicaid Services.

To provide predictability and reflect changes in medical service delivery costs to system participants, DWC established a conversion factor and an annual update as part of 28 TAC §134.203(c).  The annual update is based on the Medicare Economic Index (MEI), which is a weighted average of price changes for goods and services used to deliver physician services.  The MEI for 2017 reflects an increase of 1.2 percent.

For services provided in calendar year 2017, the new Medical Fee Guideline conversion factors are $57.50 and $72.18.  The conversion factor of $57.50 applies to service categories of evaluation and management, general medicine, physical medicine and rehabilitation, radiology, pathology, anesthesia, and surgery when performed in an office setting.  The conversion factor of $72.18 applies to surgery when performed in a facility setting.

If there are any questions about the information in this bulletin, call the toll-free Comp Connection for Health Care Providers at 1-800-372-7713.

Ryan Brannan

Commissioner of Workers’ Compensation

CY2017 Table of Conversion Factors

For more information contact: CompConnection@tdi.texas.gov

 

Health Care Claims Reimbursement Rate Report Data Call

To: Issuers of Preferred Provider Benefit Plans, Health Maintenance Organization Plans, and Specified Governmental Employee Plans in the State of Texas

The Texas Department of Insurance (TDI) issues this mandatory health care claims reimbursement rate report data call in compliance with Texas Insurance Code Chapter 38, Subchapter H. This section of the statute requires TDI to collect data concerning health benefit plan reimbursement rates in a uniform format and to disseminate the combined rates derived from this data by geographical regions in the state. The rules that implement this statute are in 28 Texas Administrative Code Chapter 21, Subchapter KK. Responding issuers should review the rules and reporting form carefully to ensure that information is reported correctly.

This data call applies to issuers of preferred provider benefit plans, health maintenance organization plans, and specified governmental employee plans under Insurance Code Chapters 1551, 1575, 1579, and 1601. Issuers must submit this data by May 1, 2017. The 2016 report covers data for claim payments from January 1, 2016, to December 31, 2016.

To respond to this data call, issuers must use the Microsoft Excel reporting form, accessible via the link at the end of this bulletin, and submit the completed form electronically to ReimbursementRates@tdi.texas.gov. To access the reporting form, responding issuers must accept the “End User Agreement” concerning use of current procedural terminology by clicking the button labeled “Accept.”

As prescribed by 28 TAC §21.4502(e), a health benefit plan issuer with fewer than 20,000 covered lives in comprehensive health coverage as reported on Part 1 of the National Association of Insurance Commissioners Supplemental Health Care Exhibit as of the end of 2016 is not required to submit a report. If you are unable to download the form, or have any questions concerning this data call, please contact TDI at ReimbursementRates@tdi.texas.gov.

Data Entry Form and Instructions

 

Related articles

Post Disclaimer

Professional Scope of Practice *

The information herein on "Annual Change To Medical Fee & Health Care Reimbursement" is not intended to replace a one-on-one relationship with a qualified health care professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional.

Blog Information & Scope Discussions

Our information scope is limited to Chiropractic, musculoskeletal, physical medicines, wellness, contributing etiological viscerosomatic disturbances within clinical presentations, associated somatovisceral reflex clinical dynamics, subluxation complexes, sensitive health issues, and/or functional medicine articles, topics, and discussions.

We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system.

Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.*

Our office has reasonably attempted to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez, DC, or contact us at 915-850-0900.

We are here to help you and your family.

Blessings

Dr. Alex Jimenez DC, MSACP, RN*, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed as a Doctor of Chiropractic (DC) in Texas & New Mexico*
Texas DC License # TX5807, New Mexico DC License # NM-DC2182

Licensed as a Registered Nurse (RN*) in Florida
Florida License RN License # RN9617241 (Control No. 3558029)
License Compact Status: Multi-State License: Authorized to Practice in 40 States*
Presently Matriculated: ICHS: MSN* FNP (Family Nurse Practitioner Program)

Dr. Alex Jimenez DC, MSACP, RN* CIFM*, IFMCP*, ATN*, CCST
My Digital Business Card