BWC
Background and updates on health care coverage and payment policies and procedures that support BWC's Health Partnership Program and Ohio self-insured employers.
Since 1912, the Ohio Bureau of Workers’ Compensation (BWC) has provided medical and compensation benefits for work-related injuries, diseases and deaths. BWC provides insurance to about two-thirds of Ohio's work force. The remaining workers receive coverage directly through their self-insured employers. BWC is the largest exclusive state-fund workers’ compensation system in the United States and the second largest underwriter of workers’ compensation insurance in the country. Ohio’s workers’ compensation system is made up of two parts: BWC, the administrative and insurance arm of the system, and the Industrial Commission of Ohio, the claims adjudicative arm.
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BWC CY 2012 Inpatient and Outpatient Hospital PPS Payment Rates
January 9, 2012:
The Ohio Bureau of Workers’ Compensation (BWC) finalized its 2012 inpatient hospital prospective payment system (IHPPS) payments rates, to be effective with discharges Feb. 1, and proposed an outpatient PPS (OPPS) rule, scheduled for adoption April 1. Both are based on their Medicare counterparts and use many of the same grouping and pricing factors, with some BWC-specific payment adjustments. BWC also has its own payment formulae for graduate medical education and outlier payments.
BWC’s 2012 IHPPS final rule (OAC 4123-6-37.1) mirrors the FFY 2012 Medicare version, but, based on comments from the OHA Finance Committee, BWC will return Medicare’s cuts to the annual inflationary update related to productivity, future coding improvements and balancing the federal budget. BWC will keep the 2.9 percent cut related to past coding improvements, but not so much because it agrees with CMS on the issue of inappropriate payments related to coding creep, as much as adopting a 2.9 percent cut to the update keeps BWC inpatient hospital payments within its own budget targets for 2012. Hospitals exempt from the Medicare IHPPS are also exempt from BWC’s version and are paid on the basis of a Medicare hospital-specific, inpatient cost-plus methodology.
BWC’s 2012 OPPS proposed rule (4123-6-37.2) includes several changes from 2011, notably in its reduction of the BWC add-on to 1.81 percent ( it was 1.97 percent in 2011, which was the first year of a two-year transition to the BWC OPPS) and in the adoption of an outpatient claims processing code editor. However, BWC will return to the inflationary base all Medicare OPPS reductions for productivity, coding improvement and balanced budgets, so BWC's proposed 2012 add-on to the outpatient Medicare PPS payment rate amounts to 2.17 percent. Childrens hospitals, cancer hospitals, Critical Access Hospitals, and rural Sole Community and Essential Access Hospitals are all exempt from the BWC OPPS and instead will be paid on the basis of their Medicare hospital-specific, outpatient cost. OHA is reviewing the BWC 2012 OPPS proposed rule and will if necessary comment at a public hearing scheduled Feb 8.
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