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SC Workers’ Compensation Commission. SC Hospital Association Managed Care Directors October 9, 2012. South Carolina Workers’ Compensation Commission. System Overview Perspective. South Carolina Workers’ Compensation Commission. General Information Organization Budget - PowerPoint PPT Presentation
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SC Workers’
Compensation Commission
SC Hospital Association
Managed Care Directors
October 9, 2012
System Overview
Perspective
South Carolina Workers’ Compensation Commission
General InformationOrganization
Budget
Statistical Information
System Cost, Premiums Paid, Taxes Paid
Current Issues/Ongoing Efforts
South Carolina Workers’ Compensation Commission
Organization
Commissioners - 7
South Carolina Workers’ Compensation Commission
Commissioners
T. Scott BeckChairman
Term Expires June 30, 2014
Susan S. Barden
Term Expires June 30, 2016
Andrea C. Roche
Term Expires June 30, 2012
Avery B. Wilkerson, Jr.Term Expires June 30, 2014
Derrick L. WilliamsTerm ExpiresJune 30, 2014
Gene McCaskillTerm Expires June 30, 2018
Melody L. JamesTerm ExpiresJune 30, 2014
South Carolina Workers’ Compensation Commission
Organization
Executive DirectorAdministrationClaims JudicialInformation TechnologyInsurance and Medical Services
South Carolina Workers’ Compensation Commission
FTE’s 54 employees
64 approved FTEs(81 in 2001)
South Carolina Workers’ Compensation Commission
Annual Budget
$4.99 million (FY12-13)
General Fund $1.7 million
Earmarked Funds $ 3.2 million
South Carolina Workers’ Compensation Commission
Claim Review Process
•Injured Worker Files Claim– Minor Medical
•No lost time•Medical Cost < $ 2,500
– Form 12 A•Submitted to Commission•Coverage determined
South Carolina Workers’ Compensation Commission
Hearing Process
•Informal Conference•Single Commissioner•Appeal - Full Commission•Appeal - Court System
Circuit Court (Pre 2007)
Court of Appeals (Post 2007)
South Carolina Workers’ Compensation Commission
South Carolina Workers’ Compensation Commission
Statistical Abstract
Accidents Filed
FY 2007 – 2012
South Carolina Workers’ Compensation Commission
Informal Conferences
Assigned & ConductedFY 2006-2012
South Carolina Workers’ Compensation Commission
Hearings Assigned & Conducted
FY 2006-2012
South Carolina Workers’ Compensation Commission
South Carolina Workers’ Compensation Commission
Appeals to Commission FY2006-12
South Carolina Workers’ Compensation Commission
Appeals to Higher Court FY06-FY12
South Carolina Workers’ Compensation Commission
Compensation & Medical Cost
FY2008-12($ millions)
South Carolina Workers’ Compensation Commission
Compensation by Category
FY2008-FY12(millions)
Work Comp Premiums (millions)
FY11 FY12Commercial Market CY 2011 $ 540.3 $ 576.5
Self Insurance FY 2012 $ 215.8 $ 210.9
State Accident Fund FY 2012 $ 86.7 $ 69.2Total $ 842.8 $ 856.3
South Carolina Workers’ Compensation Commission
Work Comp Premium Taxes (millions)
FY11 FY12Commercial Market $ 11,424,000 $ 14,407,303
Self Insurance FY 2011 $ 4,775,811$ 4,663,681
Total $ 16,199,811$ 19,070,984
South Carolina Workers’ Compensation Commission
South Carolina Workers’ Compensation Commission
Statutory Changes
&Regulatory Changes
StatutoryH 3111
• Impacts Physicians Fee Schedule
• Service providers may appeal to ALJ
• 10% change in fee schedule
• Governor Signed June 7, 2012
South Carolina Workers’ Compensation Commission
Regulations
•Mediation 67-1801
•Oral Argument 67-706
South Carolina Workers’ Compensation Commission
Mediation 67-1801•Admitted Cases 42-9-10 & 42-9-30•Occupational diseases•Third party lien reduction•Contested death•Mental/mental injury•Concurrent jurisdiction•Federal Longshore and Harbor Workers Comp Act•Multiple employees with same employer admitted or not
South Carolina Workers’ Compensation Commission
Oral Argument Regulation 67-706
•Require parties to be present 30 minutes before appellate hearing
South Carolina Workers’ Compensation Commission
Ongoing Efforts
Transparency
CommunicationEmails to StakeholdersUpdate Website
South Carolina Workers’ Compensation Commission
Ongoing Efforts
Stakeholder Advisory CommitteesFee SchedulesSurgical Implantable
DevicesCommuted Values
South Carolina Workers’ Compensation Commission
Cost Control Fee SchedulesImproved ProcessesFiling ClaimsScheduling Hearings
South Carolina Workers’ Compensation Commission
Physician’s Fee Schedule
Medicare based2010 RBRVS – Conversion Factor $50
South Carolina Workers’ Compensation Commission
Inpatient Fee Schedule
Ambulatory Surgery Fee Schedule
Medicare plus 40%
South Carolina Workers’ Compensation Commission
Pharmacy Fee Schedule•Adopted Advisory Committee•Repackaged pharmaceuticals•Physicians may dispense •MAP based on original NDC
Surgical Implantable Devices •Advisory Committee
South Carolina Workers’ Compensation Commission
Information Technology•Electronic Filing •Proof of Coverage – Notice of cancellation •Notices/Orders
Informal Conference Process•Adjusters Roundtable
South Carolina Workers’ Compensation Commission
NCCI Rate Filing
SC Vocational Rehabilitation Department
Claimant Referrals
South Carolina Workers’ Compensation Commission
Medical Services
Payment Dispute Resolution Process
SC Code of Laws - Section 42-9-360(d)
Payment to an authorized health care provider for services shall be made in a timely manner but no later than thirty days from the date the authorized health care provider tenders request for payment to the employer's representative, unless the commission has received a request to review the medical bill.
South Carolina Workers’ Compensation Commission
Medical Services
Payment Dispute Resolution Process
http://www.wcc.sc.gov/insurance/Pages/MedicalProvidersPaymentDispute.aspx
South Carolina Workers’ Compensation Commission
How can we serve you better?
System….
Processes…..
South Carolina Workers’ Compensation Commission
Contact
Gary M. [email protected]
(803) 737-5744
www.wcc.sc.gov
South Carolina Workers’ Compensation Commission
THANK YOU
South Carolina Workers’ Compensation Commission