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When in-patient hospital charges are subject to a fee schedule for
workers' compensation, these fees usually cover daily room and board
(per diem) plus diagnostic or laboratory services. This table covers
which state agency promulgates the fee schedule; the form of hospital
inpatient regulation used; how the schedules are applied and if non
emergency care requires pre-authorization by the payer. |
|
State |
Agency Responsible for Hospital Inpatient Regulation |
Hospital Inpatient Administrative Rule Number |
Date Last Updated |
Form of Hospital Inpatient Fee Regulation |
How Schedules Are Applied |
|
|
Per Case (DRG or Other) |
Per Procedure Per Diem (or by Service) |
Cost-Based |
Discounted Charges |
Other |
All Hospitals Have the Same Allowable Fees |
Hospitals Have Differing Allowable Fees Based on Location |
Hospitals Have Differing Allowable Fees Based on Size |
Hospitals Have Differing Allowable Fees Based on Negotiations |
Hospitals Have Differing Allowable Fees Based on Committee or Agency
Decision |
Other |
Pre-Authorization Required for Non-Emergency Inpatient Care |
|
Sample State 1 |
No Hospital Inpatient Regulation |
|
Sample State 2 |
The Department of Labor and Industry |
XXXX Stat. 176.X36; XXXX Rule 5221.05X |
|
|
|
|
x |
|
|
|
x |
|
|
|
No |
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Notes: |
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