Fees and charges for accident benefits: Restrictions; establishment and revision of schedule; powers and duties of Administrator; penalty for refusal to provide information; regulations.
1. All fees and charges for accident benefits must not:
(a) Exceed the amounts usually billed and paid in the state for similar treatment.
(b) Be unfairly discriminatory as between persons legally qualified to provide the particular service for which the fees or charges are asked.
2. The Administrator shall, giving consideration to the fees and charges being billed and paid in the State, establish a schedule of reasonable fees and charges allowable for accident benefits provided to injured employees whose insurers have not contracted with an organization for managed care or with providers of health care services pursuant to NRS 616B.527. The Administrator shall review and revise the schedule on or before February 1 of each year. In the revision, the Administrator shall adjust the schedule by the corresponding annual change in the Consumer Price Index, Medical Care Component.
3. The Administrator shall designate a vendor who compiles data on a national basis concerning fees and charges that are billed and paid for treatment or services similar to the treatment and services that qualify as accident benefits in this state to provide him with such information as he deems necessary to carry out the provisions of subsection 2. The designation must be made pursuant to reasonable competitive bidding procedures established by the Administrator. In addition, the Administrator may request a health insurer, health maintenance organization or provider of accident benefits, an agent or employee of such a person, or an agency of the state to provide the Administrator with information concerning fees and charges that are billed and paid in this state for similar services as he deems necessary to carry out the provisions of subsection 2. The Administrator shall require a health insurer, health maintenance organization or provider of accident benefits, an agent or employee of such a person, or an agency of the State that provides records or reports of fees and charges billed and paid pursuant to this section to provide interpretation and identification concerning the information delivered. The Administrator may impose an administrative fine of $500 on a health insurer, health maintenance organization or provider of accident benefits, or an agent or employee of such a person for each refusal to provide the information requested pursuant to this subsection.
4. The Division may adopt reasonable regulations necessary to carry out the provisions of this section. The regulations must include provisions concerning:
(a) Standards for the development of the schedule of fees and charges that are billed and paid; and
(b) The monitoring of compliance by providers of benefits with the schedule of fees and charges.
5. The Division shall adopt regulations requiring the use of a system of billing codes as recommended by the American Medical Association.
Last modified: February 25, 2006