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Ocga A 349205 Board Approval Of Physicians Fees Hospital And Other Charges Collection Of Fees Schedule Of Charges Filing Costs For Peer Review

(a)  Fees of physicians, charges of hospitals, charges for prescription drugs, and charges for other items and services under this chapter shall be subject to the approval of the State Board of Workers’ Compensation.  No physician, hospital, or other provider of services shall be entitled to collect any fee unless reports required by the board have been made.

(b)  Annually, the board shall publish a list by geographical location of usual, customary, and reasonable charges for all medical services provided under subsection (a) of this Code section.  The board may consult with medical specialists in preparing said list.  Fees within this list shall be presumed reasonable.  No physician or hospital or medical supplier shall bill the employee for authorized medical treatment; provided, however, that if an employee fails to notify a physician, hospital, or medical supplier that he or she is being treated for an injury covered by workers’ compensation insurance, such provider of medical services shall not be civilly liable to any person for erroneous billing for such covered treatment if the billing error is corrected by the provider upon notice of the same.  The board may require recommendations from a panel of appropriate peers of the physician or hospital or other authorized medical supplier in determining whether the fees submitted and necessity of services rendered were reasonable.  The recommendations of the panel of appropriate peers shall be evidence of the reasonableness of fees and necessity of service which the board shall consider in its determinations.

(c)   Any party requesting peer review pursuant to the provisions of this Code section shall pay to the board such filing costs for peer review as established by the board; provided, however, that the prevailing party in any peer review request shall be entitled to recover its filing costs, if any, from the party which does not prevail.

See also:

  • O.C.G.A. § 34-9-203. Employer’s pecuniary liability for medical charges; liability for medical malpractice; payment of reasonable charges; inclusion of reports and documentation with charges; defense for failure to make payments; penalties
  • Board Rule 61(b)(13). Form WC-20(a). Medical Report
  • Board Rule 61(b)(30). Form WC-205. Request for Authorization of Treatment or Testing by Authorized Medical Provider
  • Board Rule 203. Payment of Medical Expenses; Procedure When Amount of Expenses are Disputed
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