Morrison, 082018 ARWC, G602548

• Case Date: August 20, 2018
• Court: Kansas

CHARLES MORRISON, EMPLOYEE CLAIMANT UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCE, EMPLOYER RESPONDENT PUBLIC EMPLOYEE CLAIMS DIVISION, INSURANCE CARRIER/THIRD PARTY ADMINISTRATOR RESPONDENT ARKANSAS CHILDREN’S HOSPITAL, MEDICAL PROVIDER INTERVENER No. G602548 Arkansas Workers Compensation Before the Arkansas Workers' Compensation Commission August 20, 2018          This matter comes before ADMINISTRATIVE LAW JUDGE CHANDRA L. BLACK, on the record, on July 30, 2018, in Little Rock, Pulaski County, Arkansas.           Claimant, pro se, excused from participation.           Respondents represented by Mr. Robert Montgomery, Attorney at Law, Little Rock, Arkansas.           The provider, pro se, failed to respond.           CHANDRA L. BLACK, Administrative Law Judge.          STATEMENT OF THE CASE          This matter come before me on the record in the above-styled claim, on appeal from a ruling of the Medical Cost Containment Division.          Issue          The case at bar is being considered for the purpose of dealing with the respondent-carrier’s appeal of an 18% penalty assessed against them in the amount of $3,662.15, by the Director of the Medical Cost Containment Division of the Arkansas Workers’ Compensation Commission, due to their alleged late payment of a medical bill.          Contentions          Respondent-Carrier:

The claimant was [sic] sustained a compensable injury on April 5, 2016 and was treated at Arkansas Children’s Hospital from April 8^th to April 12, 2016. The provider has asserted that the bill for those dates of service was sent to the respondents on or about July 26, 2016. The respondents researched its records and asserts[sic] that it does not appear as though [sic] was received after July 26, 2016.

         The respondents contend that it did not receive a proper UB billing form from the provider supposedly mailed on or about July 26, 2016, as asserted by the provider. The respondents contend that the evidence reflects that it was not until August 24, 2016, that a proper UB invoice was received by either the respondents or their medical bill review provider, Systemedic. Upon receiving a properly submitted UB bill on August 24, 2016, the respondents and Systemedic acted promptly in reviewing the bill and getting the payment processed. The properly submitted UB bill was reviewed and payment was made on September 2, 2016. The initial bill review reflected that the bill did not meet the criteria of “extraordinary services payable at 150% of the fee schedule.” On or about September 2, 2016, the carrier paid $13,563.55 based on the bill review recommendation that the claimant had not suffered “major” burns as a result of his compensable injury. The provider then requested reconsideration as to whether the claimant had sustained “major” or minor burns which impacted the amount of the bill to be paid under the fee schedule.          After reconsideration by the Medical Cost Containment Division an Order was issued on April 12, 2017, finding that the claimant had in fact sustained “major” burns and the provider should be reimbursed accordingly. The carrier then promptly submitted payment on April 17, 2017 to the provider for balance of the bill as determined by the Medical Cost Containment Division. Even though payment was made promptly, the Director of the Medical Cost Containment Division assessed the carrier with an 18,% penalty for the entire amount of the bill paid(the first payment made in September, 2017 and the balance payment made in April 2017).          The respondents contend that the 18% penalty assessed is not appropriate under the circumstances. The respondents contend that they...