South-Carolina

South Carolina WORKERS COMPENSATION COLLECTION
PUBLICATIONS AND INFORMATION FOR MEDICAL PROVIDERS

Providing free information for medical providers in the collection of industrial injury medical bills

January 30, 2012: South Carolina News: This
is a Commission Advisory clarifying the
requirements for filing a Form 14B (Physician’
s Statement).

January 06, 2012: South Carolina News:
Workers' Compensation Advisory Committee
Meeting Notice

December 27, 2011: South Carolina News:
Commission Amends Pharmacy Fee Schedule

December 13, 2011: South Carolina : News:
eCase will be down for maintenance from 5:00
p.m. on December 15, 2011 until 8:30 a.m.
December 16, 2011.

November 22, 2011: South Carolina: News:
Pharmacy Fee Schedule Advisory Committee
Makes Recommendation to Commission

November 08, 2011: South Carolina : News:
SC Workers’ Compensation Commission’s
Website Gets New Look

General Information

Publications

Work Comp News and Issues

Medical Control

The employer has the right to direct an injured employee to a medical provider. The injured
employee may change medical providers with approval of the employer/insured. The employee
may select his/her own pharmacy or select a pharmacy from the Express Scripts pharmacy
network. Emergency medical care does not require preapproval and should be secured at the
nearest location.

Medical Services Division

The Medical Services Division establishes and monitors billing and payment policies for medical
services rendered to workers' compensation claimants and publishes the Medical Services Provider
Manual. Division personnel are available Monday through Friday from 8:00 a.m. to 4:30 p.m. to
answer questions pertaining to medical billing and payment policy.

Injured workers who have concerns about their medical care should contact the Claims
Department at 803-737-5723.

Medical Services Rendered in Another State

The payment rates listed in this manual are not applicable to medical services rendered outside the
state of South Carolina even when the services are provided under the South Carolina Workers'
Compensation Act. Insurers and self-insurers should negotiate rates with out-of-state providers
prior to authorizing care.
Out-of-State Injuries or Work-Related Illnesses Treated in South Carolina
It is possible that an individual may receive medical services in South Carolina for injuries incurred
in an accident under the jurisdiction of another state's workers' compensation act. In this case, the
policy and procedures listed herein would not apply. However, when a worker receives medical
services in South Carolina pursuant to the South Carolina Act, the payment is subject to the
policy listed in this document regardless of where the injury occurred. Providers may contact the
payer to determine whether benefits are being provided pursuant to South Carolina law or the
laws of another state.

2010 Medical Services Provider Manual

Any appropriately-licensed medical provider who is authorized by the employer or insurance
carrier may treat workers' compensation claimants. The Medical Services Provider Manual
outlines billing and payment policy for physicians and other health care professionals and
provides the current schedule of fees. The fee schedule does not cover hospital charges, general
dental, or services rendered outside of South Carolina.

Copies of the manual may be purchased for $75.00 by sending a check payable to the South
Carolina Workers' Compensation Commission at the following address:

S. C. Workers' Compensation Commission
Attn: Medical Services
P. O. Box 1715
Columbia, SC 29202-1715

Click the following link for a brochure and order form.
2010 Medical Services Provider Manual

2006 Hospital and Ambulatory Surgical Center Payment Manual

The Hospital and Ambulatory Surgery Center Payment Manual describes the billing and payment
policy for inpatient hospital stays and outpatient services rendered at a hospital or ambulatory
surgical center. Effective October 1, 2006, healthcare facilities will be paid 40% more than the
federal Medicare program pays for inpatient and outpatient services.

Click the links below to download a PDF version of the 2006 or 1997 Hospital and Ambulatory
Surgery Center Payment Manuals:

2006 Hospital and Ambulatory Surgery Center Payment Manual

•
Inpatient Hospital

Claims for inpatient hospital stays are paid according to a payment system based on diagnosis
related groups (DRGs). DRG is a system of classifying an inpatient stay based on the patient’s
diagnosis, medical condition and any procedures performed. Payments are hospital-specific to
account for factors such as rural/urban, number of indigent patients, teaching hospital, etc.

•Outpatient Hospital

Claims for outpatient services rendered at a hospital are paid based on grouping outpatient
services into ambulatory payment classifications (APCs). Services within an APC are similar
clinically and require comparable resources. Each APC is assigned a relative payment rate based
on the median cost of the services within that classification.

•
Ambulatory Surgical Center

Ambulatory Surgery Centers, et. al., v.SC Workers' Compensation Commission

Claims for ambulatory surgery center services are paid at the Medicare national payment rate
found at www.cms.gov/ASCPayment plus 40%.

Note: The multiple procedures rule still applies and the National Correct Coding Initiative will be
utilized in order to determine the appropriate billing of CPT and HCPCS codes

1997 Hospital and Ambulatory Surgery Center Payment Manual
DRG Conversions for 1997 Payment Manual, DRG Updates

Resources:
Update on "Pass Throughs"

Physician's Statement, Form 14B Maximum Allowable Payment

Contact Information

Bridgette Amick
803-737-5743
bamick@wcc.sc.gov