The amount a hospital is paid for services for a workers' compensation injury is adjusted. Annually, the Division of Workers' Compensation publishes an adjustment rate for hospital charges for each hospital's charges for inpatient, ambulatory surgery, and emergency room charges. The adjustments are based on approved cost finding methodology and other statistical data furnished by each hospital.
A hospital's charges should be multiplied by the corresponding percentage based on date of service, hospital, and if the type of service is inpatient, ambulatory surgery, or emergency room.
For example: Newport Hospital provided an inpatient service on July 5, 2012. Based on the chart that covers services from July 1, 2012 to June 30, 2013, the inpatient adjustment for an inpatient service at Newport Hospital is 74.76%. The total charge for the service is $1000. Multiply the charge for service by the adjustment: $1000 times 74.76% = $747.60, which is the amount Newport Hospital would be paid for that service.
For medical charges, see the Medical Fee Schedule.
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