§ 50-6-125 — Medical payment committee

Tennessee § 50-6-125

• Jurisdiction: Tennessee
• Title: 50

Text

(a) (1) The administrator shall appoint a medical payment committee. The committee shall hear disputes on medical bill payments between providers and insurers and advise the administrator on issues relating to the medical fee schedule and medical care cost containment in the workers' compensation system. Upon hearing disputes on medical bill payments between providers and insurers, the medical payment committee shall have authority to render a decision on the merits of a dispute. If the medical payment committee determines that a provider or insurer has acted in bad faith in refusing to provide payment for a medical bill or refusing to provide reimbursement for overpayment, the medical payment committee, upon a majority vote, shall refer the malfeasant provider or insurer to the bureau for consideration of assessment of a civil penalty of no more than one thousand dollars ($1,000) per occurrence. Any provider or insurer aggrieved by the assessment of a penalty under this subsection (a) shall have the right to seek review of the penalty assessment in the manner provided by § 50-6-118(c) . (2) The committee shall be comprised of seven (7) voting members appointed by the administrator as follows: (A) Three (3) members shall be representative of the medical provider industry; (B) Three (3) members shall be representative of the workers' compensation insurance industry; and (C) The medical director shall serve as the final member of the committee but shall not cast a vote unless a vote taken by members results in a tie. In that case, the medical director shall cast the deciding vote. (b) In making appointments, the administrator shall strive to achieve a geographic balance and, in the case of the physician members of the committee, shall assure, to the extent possible, that the membership of the committee reflects the diversity of specialties involved in the medical treatment and management of workers' compensation claimants. (c) Members of the committee shall serve without compensation but, when engaged in the conduct of their official duties as members of the committee, shall be entitled to reimbursement for travel expenses in accordance with uniform regulations promulgated by the department of finance and administration and approved by the attorney general and reporter. (d) Each member appointed shall serve a term of four (4) years and may be reappointed by the administrator. If a member leaves the position prior to the expiration of the term, the administrator shall appoint an individual meeting the qualifications of this section to serve the unexpired portion of the term, and the individual may be reappointed by the administrator upon expiration of the term. (e) This section applies to all disputes of medical bill payments for services provided, pursuant to this chapter, on or after July 1, 2014.

Legislative History

Acts 1992, ch. 900, § 9; 1999, ch. 520, § 41; 2004, ch. 962, § 33; 2005, ch. 105, §§ 1, 2; 2013, ch. 289, § 23; 2014, ch. 903, § 4; 2015, ch. 341, § 15.