IDAPA Rules 17.01.01.803 Medical Fees
- Workers’ Compensation medical fees are governed by IDAPA 17.01.01.803
- FY2019 Medical Fee Negotiated Rulemaking
- FY2018 Medical Fee Negotiated Rulemaking
Please contact the Medical Fee Coordinator for further information at (208) 334-6005.
PAYMENT CALCULATION RESOURCES
- 2023 National Physician Fee Schedule Relative Value File (RVU23)
- 2022 National Physician Fee Schedule Relative Value File (RVU22)
- 2021 National Physician Fee Schedule Relative Value File (RVU21)
Hospital Inpatient: MS-DRG
- Table 5: List of FY23 MS-DRGs, Relative Weights (Effective October 1, 2022)
- Table 5: List of FY22 MS-DRGs, Relative Weights (Effective October 1, 2021)
- Table 5: List of FY21 MS-DRGs, Relative Weights (Effective October 1, 2020)
Hospital Outpatient & Ambulatory Surgery Centers (ASC)
Effective January 1, 2023
Effective January 1, 2022
Effective January 1, 2021
Tips for Success in Medical Fee Disputes:
The Commission has prepared some items to help navigate the medical fee dispute process. Below are tips for filing a motion for approval of a disputed charge or a response to a motion. The Commission has also created a separate page to answer frequently asked questions.
Disclaimer: Please keep in mind these are best practices to facilitate a favorable outcome for you on your motion if you are the provider, or in defense of your handling of the bill or calculation of the acceptable charge if you are the payer. You need not be dissuaded from filing a motion or a response if you suspect that you missed a deadline or feel that you cannot provide adequate documentation. Document what you can and make your best argument.
- DO document in your motion or response:
- The date you sent or received the bill;
- The date you sent or received the Preliminary Objection or Request for Clarification;
- The date you sent or received the written Reply;
- The date you sent or received the Final Objection;
- The date and amount of any payments sent or received;
- Any other relevant actions taken in response to the above;
- A brief explanation of how you have satisfied each step of the required Procedures Preliminary to Dispute Resolution under IDAPA 17.01.01.803.06. The IDAPA rules can be downloaded from our Laws, Rules, Legislation and Policy Memos page here; and,
- If relevant, how you have calculated the acceptable charge and/ or what AMA or CMS coding guidelines you are relying on.
- DO file your motion or response timely.
- See Judicial Rule of Practice and Procedure (“JRP”) 19(E) for timelines regarding when the filing of a motion and/or response is timely. The JRP can be downloaded from our Laws, Rules, Legislation and Policy Memos page here.
- DO use the standard forms.
- The forms can be downloaded from our FAQ page here.
- DO include:
- Copies of all bills actually sent (indicating which portion of the bill is in dispute);
- The Preliminary Objection or Request for Clarification sent or received;
- The written Reply sent or received;
- The Final Objection sent or received; and,
- Any other relevant communications and/or correspondence between the parties.
- DO include a brief narrative description of the issues, actions taken, communications that occurred, or other relevant information that might bear on the calculation of the acceptable charge or support your position on the issue.
- DO understand that Commission staff are legal, not medical or coding, professionals, and that the dispute process is a legal, not medical, forum.
- DO include a Certificate of Service documenting that you sent a copy of your motion or response and all supporting documents to the other party, as required by JRP 19(C).
- If you complete service via facsimile, you must include the fax number on the Certificate of Service in addition to the name of the party served to adequately document proof of service. Although not required, it can also be helpful to include the facsimile transmission confirmation page that reflects a successful facsimile transmission.
- Remember, you can file your motion or response via email by sending it to email@example.com, but you must still serve the motion or response on the other party via facsimile, mail or personal delivery.
- DO NOT send in multiple copies of the same document. Ex.: If you are responding to a motion as a payer, it is generally not necessary to also send us a copy of the original motion and supporting documents that you received from the provider.
- DO NOT send irrelevant medical records or bills and expect the Commission staff to sort them out.
- Be specific and reference in your narrative explanation how or why each document is relevant and/or supports your position.
- If you cite to specific authorities, please include adequate details for Commission staff to be able to reference the source material (if you reference online materials, please include a link to the source page).
DO NOT hesitate to call Commission staff before you send in a motion or response to a motion if you have any questions. Please bear in mind that Commission staff will only be able to assist you with procedural matters. We cannot assist you in how to make your case.
- Medical services provided between 7/01/15 through 6/30/16
- Medical services provided between 01/01/15 through 06/30/15
- Medical services provided between 3/20/14 through 12/31/14
- Medical services provided between 07/01/13 through 03/19/14
- Medical services provided between 07/01/12 through 06/30/13
- Medical services provided between 04/07/11 through 06/30/12
- Facility services provided between 04/07/11 through 12/31/11
- Medical services provided between 03/29/10 through 04/06/11
- Medical services provided between 05/08/09 through 03/28/10
- Medical services provided between 07/01/08 through 05/07/09
- Medical services provided between 04/02/08 through 06/30/08
- Medical services provided between 03/15/07 through 04/01/08
- Medical services provided between 04/01/06* through 03/14/07
*All medical services preceding 4-01-06 are subject to usual and customary charges.
Please, direct questions regarding the medical fee schedule to the Medical Fee Coordinator.