Download - SC Workers’ Compensation Commission
![Page 1: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/1.jpg)
SC Workers’
Compensation Commission
SC Hospital Association
Managed Care Directors
October 9, 2012
![Page 2: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/2.jpg)
System Overview
Perspective
South Carolina Workers’ Compensation Commission
![Page 3: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/3.jpg)
General InformationOrganization
Budget
Statistical Information
System Cost, Premiums Paid, Taxes Paid
Current Issues/Ongoing Efforts
South Carolina Workers’ Compensation Commission
![Page 4: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/4.jpg)
Organization
Commissioners - 7
South Carolina Workers’ Compensation Commission
![Page 5: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/5.jpg)
Commissioners
T. Scott BeckChairman
Term Expires June 30, 2014
Susan S. Barden
Term Expires June 30, 2016
Andrea C. Roche
Term Expires June 30, 2012
Avery B. Wilkerson, Jr.Term Expires June 30, 2014
Derrick L. WilliamsTerm ExpiresJune 30, 2014
Gene McCaskillTerm Expires June 30, 2018
Melody L. JamesTerm ExpiresJune 30, 2014
South Carolina Workers’ Compensation Commission
![Page 6: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/6.jpg)
Organization
Executive DirectorAdministrationClaims JudicialInformation TechnologyInsurance and Medical Services
South Carolina Workers’ Compensation Commission
![Page 7: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/7.jpg)
FTE’s 54 employees
64 approved FTEs(81 in 2001)
South Carolina Workers’ Compensation Commission
![Page 8: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/8.jpg)
Annual Budget
$4.99 million (FY12-13)
General Fund $1.7 million
Earmarked Funds $ 3.2 million
South Carolina Workers’ Compensation Commission
![Page 9: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/9.jpg)
Claim Review Process
•Injured Worker Files Claim– Minor Medical
•No lost time•Medical Cost < $ 2,500
– Form 12 A•Submitted to Commission•Coverage determined
South Carolina Workers’ Compensation Commission
![Page 10: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/10.jpg)
Hearing Process
•Informal Conference•Single Commissioner•Appeal - Full Commission•Appeal - Court System
Circuit Court (Pre 2007)
Court of Appeals (Post 2007)
South Carolina Workers’ Compensation Commission
![Page 11: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/11.jpg)
South Carolina Workers’ Compensation Commission
Statistical Abstract
![Page 12: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/12.jpg)
Accidents Filed
FY 2007 – 2012
South Carolina Workers’ Compensation Commission
![Page 13: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/13.jpg)
Informal Conferences
Assigned & ConductedFY 2006-2012
South Carolina Workers’ Compensation Commission
![Page 14: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/14.jpg)
Hearings Assigned & Conducted
FY 2006-2012
South Carolina Workers’ Compensation Commission
![Page 15: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/15.jpg)
South Carolina Workers’ Compensation Commission
Appeals to Commission FY2006-12
![Page 16: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/16.jpg)
South Carolina Workers’ Compensation Commission
Appeals to Higher Court FY06-FY12
![Page 17: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/17.jpg)
South Carolina Workers’ Compensation Commission
Compensation & Medical Cost
FY2008-12($ millions)
![Page 18: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/18.jpg)
South Carolina Workers’ Compensation Commission
Compensation by Category
FY2008-FY12(millions)
![Page 19: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/19.jpg)
Work Comp Premiums (millions)
FY11 FY12Commercial Market CY 2011 $ 540.3 $ 576.5
Self Insurance FY 2012 $ 215.8 $ 210.9
State Accident Fund FY 2012 $ 86.7 $ 69.2Total $ 842.8 $ 856.3
South Carolina Workers’ Compensation Commission
![Page 20: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/20.jpg)
Work Comp Premium Taxes (millions)
FY11 FY12Commercial Market $ 11,424,000 $ 14,407,303
Self Insurance FY 2011 $ 4,775,811$ 4,663,681
Total $ 16,199,811$ 19,070,984
South Carolina Workers’ Compensation Commission
![Page 21: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/21.jpg)
South Carolina Workers’ Compensation Commission
Statutory Changes
&Regulatory Changes
![Page 22: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/22.jpg)
StatutoryH 3111
• Impacts Physicians Fee Schedule
• Service providers may appeal to ALJ
• 10% change in fee schedule
• Governor Signed June 7, 2012
South Carolina Workers’ Compensation Commission
![Page 23: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/23.jpg)
Regulations
•Mediation 67-1801
•Oral Argument 67-706
South Carolina Workers’ Compensation Commission
![Page 24: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/24.jpg)
Mediation 67-1801•Admitted Cases 42-9-10 & 42-9-30•Occupational diseases•Third party lien reduction•Contested death•Mental/mental injury•Concurrent jurisdiction•Federal Longshore and Harbor Workers Comp Act•Multiple employees with same employer admitted or not
South Carolina Workers’ Compensation Commission
![Page 25: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/25.jpg)
Oral Argument Regulation 67-706
•Require parties to be present 30 minutes before appellate hearing
South Carolina Workers’ Compensation Commission
![Page 26: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/26.jpg)
Ongoing Efforts
Transparency
CommunicationEmails to StakeholdersUpdate Website
South Carolina Workers’ Compensation Commission
![Page 27: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/27.jpg)
Ongoing Efforts
Stakeholder Advisory CommitteesFee SchedulesSurgical Implantable
DevicesCommuted Values
South Carolina Workers’ Compensation Commission
![Page 28: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/28.jpg)
Cost Control Fee SchedulesImproved ProcessesFiling ClaimsScheduling Hearings
South Carolina Workers’ Compensation Commission
![Page 29: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/29.jpg)
Physician’s Fee Schedule
Medicare based2010 RBRVS – Conversion Factor $50
South Carolina Workers’ Compensation Commission
![Page 30: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/30.jpg)
Inpatient Fee Schedule
Ambulatory Surgery Fee Schedule
Medicare plus 40%
South Carolina Workers’ Compensation Commission
![Page 31: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/31.jpg)
Pharmacy Fee Schedule•Adopted Advisory Committee•Repackaged pharmaceuticals•Physicians may dispense •MAP based on original NDC
Surgical Implantable Devices •Advisory Committee
South Carolina Workers’ Compensation Commission
![Page 32: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/32.jpg)
Information Technology•Electronic Filing •Proof of Coverage – Notice of cancellation •Notices/Orders
Informal Conference Process•Adjusters Roundtable
South Carolina Workers’ Compensation Commission
![Page 33: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/33.jpg)
NCCI Rate Filing
SC Vocational Rehabilitation Department
Claimant Referrals
South Carolina Workers’ Compensation Commission
![Page 34: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/34.jpg)
Medical Services
Payment Dispute Resolution Process
SC Code of Laws - Section 42-9-360(d)
Payment to an authorized health care provider for services shall be made in a timely manner but no later than thirty days from the date the authorized health care provider tenders request for payment to the employer's representative, unless the commission has received a request to review the medical bill.
South Carolina Workers’ Compensation Commission
![Page 35: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/35.jpg)
Medical Services
Payment Dispute Resolution Process
http://www.wcc.sc.gov/insurance/Pages/MedicalProvidersPaymentDispute.aspx
South Carolina Workers’ Compensation Commission
![Page 36: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/36.jpg)
How can we serve you better?
System….
Processes…..
South Carolina Workers’ Compensation Commission
![Page 37: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/37.jpg)
Contact
Gary M. [email protected]
(803) 737-5744
www.wcc.sc.gov
South Carolina Workers’ Compensation Commission
![Page 38: SC Workers’ Compensation Commission](https://reader036.vdocuments.net/reader036/viewer/2022062721/5681372c550346895d9eb714/html5/thumbnails/38.jpg)
THANK YOU
South Carolina Workers’ Compensation Commission