Wyoming Administrative Code
Agency 053 - Workforce Services, Department of
Sub-Agency 0021 - Workers' Compensation Division
Chapter 9 - FEE SCHEDULES
Section 9-9 - Facility Fees

Universal Citation: WY Code of Rules 9-9

Current through September 21, 2024

(a) Fees for Inpatient Hospital Services.

(i) Inpatient hospital services shall be reimbursed in accordance with the CMS IPPS (Inpatient Prospective Payment System) payment methodology. With the Wyoming Base Rate at 150% of Medicare; updated on July 1st of each year; and the MS-DRG (Medicare Severity-Diagnosis Related Group) weight according to the CMS Table 5 (for the corresponding year of service) found at: https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/fy-2024-ipps-final-rule-home-page.

(ii) Medical services for which there is no inpatient weight listed shall be reimbursed at eighty percent (80%) of the reasonable charge.

(iii) If the inpatient admission and discharge occurs across different calendar years, the Base Rate and MS-DRG weight of the admission year shall be used for the entirety of the inpatient stay.

(iv) Required documentation to support billed charges are as follows:
(A) Detailed itemization;

(B) Anesthesia graphic;

(C) Operative report;

(D) History and physical;

(E) Discharge summary;

(F) Implant Log and itemization; and

(G) Supplier's invoice for any supplies and/or implants charged at five thousand dollars ($5,000.00) or more, per episode of care, for device intensive procedures as indicated by Medicare. Such items shall be reimbursed at one hundred fifteen percent (115%) of invoice amount. Shipping and handling charges shall not be reimbursed.

(v) Bills shall be audited for unidentified and unrelated services and/or items.

(vi) The Division shall provide a copy of the audit upon request.

(b) Critical Access Hospitals (CAH) inpatient services will be paid at one hundred fifty percent (150%) of Rural Cost-to-Charge Ratio (CCR) in accordance with the Wyoming Medicare file CMS-1771-P Tables 8A and 8B for the year of service submitted. More information can be found at: https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/fy-2024-ipps-final-rule-home-page.

(i) Critical Access Hospital (CAH) outpatient services will be paid in accordance with the conversion factors and methodologies listed in Section 2(c).

(c) Fees for Skilled Nursing Services.

(i) Inpatient Skilled Nursing Services shall be reimbursed in accordance with the Annual Skilled Nursing Facility Per Diem Room Rate Survey conducted by the Division.
(A) If the facility has not established a per diem room rate with the Division for the calendar year corresponding to the date of service, the average of the submitted rates will be used.

(ii) The per diem room rates for a semi-private bed shall be the usual and customary rates charged to the general public. Such rates shall be effective automatically on the first day of each calendar year.
(A) The per diem room rates will be all inclusive of the care for the claimant for the day. This includes but is not limited to:
(I) Administration of oxygen and related medication;

(II) Hand feedings;

(III) Incontinence Care;

(IV) Tray Service;

(V) Therapy Services, including physical therapy, occupational therapy, speech and language therapy; and

(VI) Over the counter medications.

(B) Certain items are permitted to be billed outside of the per diem rate, such as:
(I) Ambulance services when medically necessary;

(II) Some durable medical equipment (DME) items;

(III) Wheelchairs;

(IV) Braces;

(V) Medical services including laboratory, radiology and surgical procedures;

(VI) Physician and other practitioner services, excluding physical therapy, occupational therapy and speech and language therapy; and

(VII) Prosthetics.

(d) Fees for Inpatient Rehabilitation Services.

(i) Inpatient Rehabilitation Services shall be reimbursed at eighty percent (80%) of billed charges.

(ii) Required documents to support billed charges are as follows:
(A) History and physical;

(B) Daily notes including physician visits, therapy notes, nursing notes, etc.; and

(C) Discharge summary, if applicable.

(iii) Bills shall be audited for unidentified and unrelated services and/or items.

(iv) The Division shall provide a copy of the audit upon request.

(e) Fees for Ambulatory Surgery Services.

(i) Ambulatory Surgery Services shall be reimbursed in accordance with Wyoming Medicare Ambulatory Surgery Center (ASC) rates at one hundred fifty percent (150%) of the allowed amount, found at: https://www.cms.gov/medicare/medicare-fee-for-service-payment/ascpayment/11_addenda_updates.

(ii) Medical services for which there is no ASC weight listed shall be reimbursed at eighty percent (80%) of the reasonable charge.

(iii) All payment status indicators shall be followed as indicated by Medicare.

(iv) Required documentation to support billed charges are as follows:
(A) Operative report;

(B) Implant Log and itemization; and

(C) Supplier's invoice for any supplies and/or implants charged at one thousand dollars ($1,000.00) or more, per episode of care. Such items shall be reimbursed at one hundred fifteen percent (115%) of invoice amount. Shipping and handling charges shall not be reimbursed.

(v) Bills shall be audited for unidentified and unrelated services and/or items.

(vi) The Division shall provide a copy of the audit upon request.

(f) Fees for Outpatient Facility Services.

(i) Outpatient Services shall be reimbursed in accordance with Wyoming Medicare Ambulatory Payment Classifications (APC) rates at one hundred fifty percent (150%) of the allowed amount, found at: https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient/addendum-a-b-updates.

(ii) Required documentation to support billed charges are as follows:
(A) Treatment notes to support the billed services.

(B) All test results.

(iii) Bills shall be audited for unidentified and unrelated services and/or items.

(iv) The Division shall provide a copy of the audit upon request.

Disclaimer: These regulations may not be the most recent version. Wyoming may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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