If the payer is supposed to pay a percentage of the charged amount for equipment, implants, etc., can it demand a copy of the invoice?
This issue is controversial. There are allegations that some charges for devices are being marked up several times over normal amounts. Future court cases may set precedent on this issue. Generally, if there is a dispute over a medical bill, and the parties are not able to resolve it themselves, the employer/employee would bring the issue before an arbitrator for resolution. Section 16 of the WC Act authorizes the Commission to set the reasonableness of fees, and Section 8.2 requires that the payer pay a bill within 60 days of receipt of the bill as long as it contains substantially all the required data elements necessary to adjudicate the bills. In the Rules, Section 7110.90(e) states that certain revenue codes (e.g., implants) “are to be deducted from the charge and reimbursed at 65% of charge billed at the provider’s normal rates under its chargemaster. A standard chargemaster is the provider’s list of charges… used to bill payers in a consistent manner.” If a payer disputes a bi
Related Questions
- If the payor is supposed to pay a percentage of the charged amount, can it require the medical provider to submit a copy of the invoice?
- If the payer is supposed to pay a percentage of the charged amount for equipment, implants, etc., can it demand a copy of the invoice?
- I cannot afford to pay the fees charged by the agency or official to research my request or copy the records. Can I get a waiver?
