Montana Facility Fee Schedule
Steadily Onward and Upward
Phew! We have finally made it through the launch of the new Montana Facility Fee Schedule (MFFS). The transition has been a little “bumpy” at times, but we are getting “the hang of it!” There has been a significant learning curve as everyone adjusts to the new methodology as adopted bythe Department of Labor & Industry (DLI). Montana State Fund (MSF) Medical Team employees attended training sessions that DLI recently offered. MSF also brought in an expert for some additional training in May. We continue to solicit feedback from DLI as issues arise and encourage you to contact them if you still have questions. You may also access their website at http://erd.dli.mt.gov/wcstudyproject/mffsoverview.asp.
Some “Facility” Housekeeping
When submitting implant invoices that reach the outlier threshold, please DO NOT use a highlighter to identify those items used. Bills cannot be scanned in color and highlighting only blacks out the information. Please circle or check the items used for the procedure. Implant thresholds are $10,000.00 in cost for inpatient hospital and $500.00 in cost for outpatient hospital and ambulatory surgical centers. Reference (ARM) 24.29.1432 (11(e)) and (12(f)) for more information.
Why do we need documentation?
Documentation is an important piece of an injured employee’s (IE’s) treatment: it tells us what treatment is being provided, what additional treatment is planned or needed, what the IE’s improvement status is and how they are responding to the treatment plan. In general, office notes need to be submitted with every bill and should contain those elements, along with any recommendations and/or referrals for other therapies that may help return the IE to health and the workplace. Of note, treatment should be related to the injury of record in order to be considered for payment. If an IE is seeking treatment for conditions not related to the injury, they should make a separate appointment to have those issues addressed or you may receive a denial for your bill. For more information, reference ARM 24.29.1513.
Note: For facility billing, documentation is not usually required for inpatient hospital or ASC unless submitting implant invoices. Exceptions include new claims and outpatient services for ER, laboratory, radiology, physical therapy and critical access facilities. If inpatient or ASC bills are submitted for new claims without records we cannot process until the records are received. This documentation is often the first available to review for compensability.