Section 7-212. MEDICAL SERVICES AND SUPPLIES

 

212.1Under §8(a) of the Act [§36-307(a), D.C. Code 1981], the employer of an injured employee shall furnish medical services and supplies for that period of time as the nature of the injury or the process of recovery may require.

 

212.2Under §8(b)(3) of the Act [§36-307(b)(3),D.C. Code, 1991 Supplement], an injured employee has the right to choose any attending or treating physician on or after March 6, 1991 subject to the provisions of §212.13 of this Chapter.

 

212.3If there is need for immediate treatment and, due to the nature of an injury, the injured employee is unable to select a physician, the employer may select a physician to provide initial treatment to the employee. Provided, however, that for purposes of §212.12 of this section, a physician selected by the employer shall not be considered to have been selected by the employee.

 

212.4The physician shall file an initial medical report with the Office and the employer containing a diagnosis and prognosis within twenty (20) working days of treatment in accordance with §8(d) of the Act (§36-307(d), D.C. Code, 1981 ed.]

 

212.5Any medical care provider who continues to treat an injured employee shall, at no cost, provide periodic progress reports, treatment records, and bills upon request to the Office, the injured employee, the employer, or the insurer, or their representatives.

 

212.6Any medical care provider who has properly submitted a bill who is not paid in a timely fashion can make a complaint to the Office.

 

212.7Upon receiving a complaint regarding payment delinquencies, the Office shall investigate the complaint and attempt to resolve it informally.

 

212.8In no event shall a medical care provider attempt to collect a disputed bill for medical services provided in connection with a compensable claim under the Act from the claimant or beneficiary.

 

212.9All medical providers shall include in each medical report and bill for services rendered under the Act, the code as published by the American Medical Association in the most current edition of the Physicians Current Procedural Terminology, commonly known as CPT Codes, for the detailing of the billing of all medical procedures and the codes established by the most recent edition of the International Classification of Diagnosis, as published by the U.S. Department of Health and Human Services, commonly known as the ICD Code, for diagnosis.

 

212.10To the maximum extent feasible, any hearing regarding a disputed medical service or care or fee charged shall be consolidated with the hearing regarding other issues in dispute on a specific claim.

 

212.11The insurer may require a medical report from a medical care provider to substantiate payment of bills. The report may be submitted on a form prescribed by the Office or may be typewritten on the physician's letterhead, signed and dated by the attending physician.

 

212.12Once a medical care provider is selected to provide treatment under the Act, an injured employee shall not change to another medical care provider or hospital without authorization of the insurer or the Office, except in an emergency. Notice of the provision of emergency care shall be provided to the insurer and the Office within a reasonable time after the care is rendered.

 

212.13If the employee is not satisfied with medical care, a request for change may be made to the Office. The Office may order-a change where it is found to be in the best interest of the employee.

 

212.14Medical care, services, and supplies provided on or after April 16, 1999 shall be billed by the provider at 113% of Medicare's reimbursement amounts.

 

212.15Under §16(h) of the Act [§36-315(h), D.C. Code, 1981 ed.]  and §21(f) of the Act [§36-320(f), D.C. Code, 1981 ed.], the Office may require an injured employee to submit to physical examinations at times and places reasonably convenient for the employee.

 

212.16In determining convenience of place of examination, the Office shall consider the following:

 

(a)The distance to be traveled;

 

(b)The physical condition of the employee; and

 

(c)The various modes of transportation available to the employee.

 

212.17The cost of physical examinations ordered by the Office shall be paid by the insurer unless a determination is made by the Office that the cost is appropriately charged to the Special Fund in accordance with § 231 of this chapter.

 

212.18Mileage shall be assessed in accordance with the mileage rates set by the Superior Court of the District of Columbia.

 

source

Notice of Final Rulemaking published at 41 DCR 3213 (June 3, 1994); as amended by Final Rulemaking published at 47 DCR 6454 (August 11, 2000).