Louisiana Medical Bill Reviewer Training Program. Unit 1: Professional Services Introduction and General Guidelines. Hi! I’m one of the symbols of Louisiana.
Unit 1: Professional Services
Introduction and General Guidelines
I’m here to guide you on a tour of our Workers’ Compensation fee schedule rules. Together, we’ll become familiar with the unique aspects of our guidelines.Overview
Part I: General Information
The Louisiana Office of Workers’
Compensation Administration (OWCA) was
created in 1983 in order to administer the
Louisiana Workers’ Compensation Act.
The Workers’ Compensation Board of
Commissioners consist of 12 members, 9 are
appointed by the Governor.
State Capital Building
Baton Rouge, LA
Which workers are covered?
The Louisiana Workers’ Compensation Act provides for:
Benefits are paid by:
(for work-related deaths paid to dependent survivors)
Periodic updates are provided by the state to allow the schedules to
The Workers’ Compensation Program is a large melting pot of many different entities.
Now that you are familiar with the framework of Louisiana Workers’ Comp, let’s take a look at some general guidelines & instructions...
by zip code location and
How do I find a Louisiana locator code?
Let’s take a look…
Step 1: Access Bill Review 4 Reference Materials
Step 2: Choose State Reference Guides
Step 3: Choose Fee Schedule Location Table
Step 4: Find the provider’s zip code and the effective date of service on the table to locate the provider’s fee schedule locality.
In Louisiana, altering codes is not allowed. Key the procedure as billed.
Balance Billing is prohibited by Louisiana
Procedures that are integral parts of a total service DO NOT warrant separate identification or reimbursement.Separate Procedures
Let’s take a look…
CPT 95851, which codes for a Range of Motion procedure, is an essential part of a follow up visit for a shoulder injury. Therefore, it WOULD NOT warrant separate reimbursement.
However, if this procedure were the only service performed, it would be considered a separate procedure and should be ALLOWED.
Every effort should be made to identify the service performed with a specific code rather than an unlisted procedure.
If the necessity of the services has been verified, and the service authorized, additional information may be requested about the procedure, or an online search may be performed.
The unlisted code billed may represent a slightly different version of an established code which would still be appropriate.
Procedure codes that do not have a listed value will be recommended for payment at the UCR percentage allowance.
to identify the service
performed with a specific
code rather than an unlisted
Hmm, which code should I use?
often misuse the unlisted
code when a more
appropriate code is
Although, the system will suspend for the user to verify the correct type of service.
Modifiers will be covered in the context of billed codes.
Modifiers may indicate circumstances such as:
But, as you can see, knowing how to calculate reimbursements may help you identify errors during bill review or troubleshoot problems when reviewing challenging bills.
Defined Locator Codes
How reimbursements are calculated.Summary