As we recently reported, according to the IWCC website, the Commission repealed emergency rules and withdrew proposed rules on implants and ASTCs on October 28, 2010. What this specifically means to our clients is that medical treatment on or after July 6, 2010 and on or before October 28, 2010 should be paid pursuant to the emergency rules:
1. Reimbursement for a medical implant shall be 25% over the manufacturer’s invoice price less rebates, plus actual and customary shipping costs incurred for the implant.
2. In the Ambulatory Surgical Treatment Center (ASTC) fee schedule, facilities accredited for surgical treatment by either AAAASF, AAAHC, or JCAHO were specifically deemed to be eligible for the payment of ASTC facility fees.
The IWCC website indicates that the ” Commission will continue to formulate solutions to the perceived problems of accredited facilities and pricing of medical implants.” Specific solutions are not mentioned, but Inman & Fitzgibbons will continue to keep our clients advised of any further pricing updates .