Nebraska Workers Compensation Fee Schedule 2018
The Nebraska workers compensation fee schedule for 2018 sets the reimbursement framework for medical services provided to injured workers. The schedule is governed by the Nebraska Workers Compensation Act and the administrative rules of the Nebraska Workers Compensation Court. Fee values are derived from a percentage of the Medicare Physician Fee Schedule (MPFS), adjusted for the state's specific medical cost environment. Understanding the 2018 schedule requires looking at the base year, the applicable multiplier, and the types of services covered.
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How the 2018 Nebraska Fee Schedule Was Constructed
The 2018 schedule uses a base year of 2016, with fees updated through a statutory multiplier formula. The Nebraska Workers Compensation Court sets this multiplier periodically, reflecting changes in medical practice costs. The schedule applies to all covered medical treatments, including hospital services, physician visits, diagnostic tests, and durable medical equipment. The court may also adopt interim fee schedules when the permanent schedule is under revision, ensuring providers receive timely reimbursement while the rules are updated.
Key Rate Components and Service Categories
Medical fees in the Nebraska workers compensation system are categorized by service type. Each category has a specific pricing methodology tied to the Medicare base rate. The following table outlines the primary service categories and how they were treated under the 2018 schedule.
| Service Category | Pricing Basis | 2018 Notes |
|---|---|---|
| Physician Services | MPFS percentage | Standard evaluation and management codes |
| Hospital Outpatient Services | MPFS-adjusted | Ambulatory surgery and clinic visits |
| Diagnostic Testing | MPFS percentage | Imaging and lab services |
| Physical Medicine | MPFS percentage | Includes chiropractic and rehabilitation |
| Durable Medical Equipment | MPFS or LMRP | Prosthetics and orthotics |
Physical medicine services, including chiropractic treatment, are subject to specific visit limits and documentation requirements. The fee schedule defines the maximum reimbursement for these procedures, and providers must submit claims with proper medical coding to receive payment.
Administrative Rules and Fee Updates
The Nebraska Workers Compensation Court has the authority to amend the fee schedule. In 2018, the court continued its practice of reviewing medical fees to align with national benchmarks and state-specific cost trends. Providers should consult the court's published orders and the Nebraska Revised Statutes for the exact multiplier and any interim adjustments. The court's website publishes the fee schedule tables and supporting documentation used for claims adjudication.
Impact on Claims Processing
The 2018 fee schedule directly affects how claims adjusters evaluate medical bills. Bills exceeding the scheduled fee may be disputed, requiring a hearing before the Workers Compensation Court. Providers are expected to bill at the scheduled rate for covered services. For services not listed in the schedule, the court may use a reasonableness standard to determine reimbursement, often referencing the Medicare fee schedule as a baseline.