Medical Services Division
The Medical Services Division establishes and monitors billing and payment policies for medical services rendered to workers' compensation claimants and publishes the Medical Services Provider Manual. Division personnel are available Monday through Friday from 8:00 a.m. to 4:30 p.m. to answer questions pertaining to medical billing and payment policy.
Injured workers who have concerns about their medical care should contact the Claims Department at 803-737-5723.
Any appropriately-licensed medical provider who is authorized by the employer or insurance carrier may treat workers' compensation claimants. The 2003 Medical Services Provider Manual outlines billing and payment policy for physicians and other health care professionals and provides the current schedule of fees. The fee schedule does not cover hospital charges, general dental, or services rendered outside of South Carolina.
Copies of the manual may be purchased for $60.00 each plus $3.60 South Carolina sales tax by sending a check payable to the South Carolina Workers' Compensation Commission at the following address:
S. C. Workers' Compensation Commission
Attn: Medical Services
P. O. Box 1715
Columbia, SC 29202-1715
2006 Hospital and Ambulatory Surgical Center Payment Manual
The Hospital and Ambulatory Surgery Center Payment Manual describes the billing and payment policy for inpatient hospital stays and outpatient services rendered at a hospital or ambulatory surgical center. Effective October 1, 2006, healthcare facilities will be paid 40% more than the federal Medicare program pays for inpatient and outpatient services.
Links :
2006 Hospital and Ambulatory Surgery Center Payment Manual
1997 Hospital and Ambulatory Surgery Center Payment Manual
DRG Conversions for 1997 Payment Manual, DRG Updates
Update on "Pass Throughs"
Claims for inpatient hospital stays are paid according to a payment system based on diagnosis related groups (DRGs). DRG is a system of classifying an inpatient stay based on the patient’s diagnosis, medical condition and any procedures performed. Payments are hospital-specific to account for factors such as rural/urban, number of indigent patients, teaching hospital, etc.
Claims for outpatient services rendered at a hospital are paid based on grouping outpatient services into ambulatory payment classifications (APCs). Services within an APC are similar clinically and require comparable resources. Each APC is assigned a relative payment rate based on the median cost of the services within that classification.
Ambulatory surgery centers are to be paid at 12.1% discount to charge based on current litigation. This is a change from what is stated in the above 2006 Hospital and Ambulatory Surgery Center Payment Manual.
Note: The multiple procedures rule still applies and the National Correct Coding Initiative will be utilized in order to determine the appropriate billing of CPT and HCPCS codes
Contact Information
Bridgette Amick
803-737-5743
bamick@wcc.sc.gov