Nabraska

January 20, 2012: Nebraska News:
Vocational Rehabilitation Meeting
Announcement & Results of the 10/28/2011
Meeting

December 27, 2011: N e braska News:
Schedules of Fees for Hospitals and
Ambulatory Surgical Centers, Implantable
Medical Devices, Diagnostic Related Group
(DRG) Inpatient Hospital, and Trauma
Services Inpatient Hospital

November 12: 2011: Nebraska ; News:
The notice, agenda, proposed rule
amendments, proposed Fee Schedule for
Hospital and Ambulatory Surgical Centers,
and proposed Fee Schedule for Implantable
Medical Devices

November 01, 2011:Nebraska ; News:
Press Release: Effective January 1, 2012, the
maximum weekly income benefit under the
Nebraska Workers' Compensation Act will
increase to $710.00.

General Information

Publications

Work Comp News and Issues

Medical Control

The injured employee has the right to select a medical provider who has
maintained medical records of the injured employee (or an immediate family
member). If the injured employee does not have or does not choose such a medical
provider, the employer may select the medical provider. If the employer does not
give proper notice to the injured employee regarding the right of selection,
restrictions for choosing and changing medical providers do not apply and the
injured employee has the right to select any medical provider. The employee may
select his/her own pharmacy or select a pharmacy from the Express Scripts
pharmacy network. Emergency medical care should be secured at the nearest
location

State Fee Schedule

Except as otherwise provided in this schedule, services by a hospital or
ambulatory surgical center shall be reimbursed in accordance with the following.
Tier I: All hospitals and all licensed ambulatory surgical centers located in or
within 15 miles of a Nebraska city of the metropolitan class or primary class and
all hospitals and ambulatory centers located outside the boundaries of
the State of Nebraska shall be Tier I facilities. The fee under this schedule for a
Tier I facility shall be 85 percent of billed charges.
Tier II: Hospitals with 51 or more licensed beds and not classified under Tier I and
licensed ambulatory surgical centers located in or within 15 miles of a Nebraska
city of the First Class shall be Tier II facilities. The fee under this schedule for a
Tier II facility shall be 92.5 percent of billed charges.Tier III: Hospitals with 50
licensed beds or less and not classified under Tier I, all critical access hospitals, and
all licensed ambulatory surgical centers not classified under Tier I or Tier II shall be
Tier III facilities. The fee under this schedule for a Tier III facility shall be 96
percent of billed charges.

Trauma service?

(See Rule 26,C)
C. Claims for inpatient trauma services submitted by hospitals identified in section
48-120(1)(c) prior to January 1, 2011 shall be reimbursed under the schedule of
fees established by Rule 26,A,2, unless otherwise contracted pursuant to section
48-120(1)(d). A claim for inpatient trauma services shall mean a claim which has at
least one of the following ICD-9-CM diagnosis codes in UB-04 Form Locator 67:
Injury codes in the range of 800-959.9,
994.1 (drowning), 994.7 (asphyxiation and strangulation), or 994.8
(electrocution); and either:
1. The patient was admitted to the hospital from the emergency department (UB-
04 Form Locator 14 with Priority (Type) of Visit as: 1-Emergency, or 5-Trauma),
or
2. The patient was transferred out of the hospital (UB-04 Form Locator
17 with Patient Discharge Status 02- Discharged/transferred to a Short
Term General Hospital for Inpatient Care), or
3 The patient was admitted directly to the hospital, bypassing the emergency
department (UB-04 Form Locator 14 with Priority (Type) of Visit as:
1-Emergency, or 5-Trauma), or
4. The patient died in the emergency department (UB-04 Form Locator
17 with Patient Discharge Status 20-Expired), or
5. The patient was dead on arrival in the emergency department (UB-04 Form
Locator 17 with Patient Discharge Status 20-Expired).
Sections 48-120, 48-120.04, R.S. Supp., 2009.
Effective date December 15, 2009

Trauma Services Inpatient Hospital Fee Schedule
Download

NEBRASKA WORKERS COMPENSATION
COMPREHENSIVE PUBLICATIONS AND INFORMATION
FOR INDUSTRIAL INJURIES