Section 20-2-V - MWCC REVIEW OF A DISPUTEA. Any party aggrieved by the decision of the Cost Containment Division shall have twenty (20) days from the date of said decision to request review by the MWCC. Unless permitted to appear pro se, all parties participating in MWCC review of a decision of the Cost Containment Division are required to be represented by an attorney licensed in Mississippi. Failure to file a written request for review with the MWCC within this twenty (20) day period shall bar any further review or action with regard to the issue(s) presented. A decision of the Cost Containment Division that is not timely appealed shall constitute a final decision of the Full MWCC, with all findings and determinations of the Cost Containment Director, including the award of penalties, interest, and attorney's fees and/or expenses, to be considered as having been awarded by the Full MWCC itself, including any penalty under Mississippi Code Annotated Section 71-3-59. No extension of time within which to file for MWCC review of a dispute under these Rules shall be allowed. In the event a request for review is not filed with the MWCC within twenty (20) days, the parties to the dispute shall have fourteen (14) days thereafter in which to comply with the final decision of the Cost Containment Division.
A party to a dispute may, when a written request for review has not been timely filed with the MWCC, seek enforcement of payment of that decision pursuant to the terms and time period set forth in Mississippi Code Annotated Section 71-3-49. A Final Decision of the Cost Containment Division and/or the MWCC shall be considered sufficient to allow the payer and/or provider to pursue any and all remedies available to it for enforcement of payment in default pursuant to Mississippi Code Annotated Section 71-3-49. No further action to enforce payment shall be made by the MWCC, nor shall any other document be issued regarding the dispute unless the MWCC finds the issuance of such document to be necessary. The payer and/or provider shall be solely responsible for calculating the interest and penalty owed to it pursuant to the terms of the Fee Schedule, and any dispute regarding enforcement of payment in default and/or the amount of interest or penalty due shall be determined by the Court wherein the payer or provider has sought enforcement pursuant to Mississippi Code Annotated. Section 71-3-49. The same procedure for enforcement above shall also be applicable to all final decisions of the MWCC in the event the decision of the Cost Containment Division was timely appealed to the MWCC and a final decision of the MWCC has been issued.
B. The request for review by the MWCC shall be filed with the Cost Containment Division of the Mississippi Workers' Compensation Commission, shall be in writing, and shall state the grounds on which the requesting party relies. All documentation submitted to and considered by the Cost Containment Division, including the Request for Resolution of Dispute form, along with a copy of the decision of the Cost Containment Division, shall be attached to the request for review which is filed with the MWCC. The party seeking relief hereunder shall certify that a copy of the request for review and any supporting documentation being filed with the MWCC has been provided to the other interested parties or their representatives by certified mail simultaneously with the filing to the MWCC. Unlike the Request for Resolution of Dispute Form, there is no specific prescribed form for a Request for MWCC Review. C. The MWCC shall review the issue(s) solely on the basis of the documentation submitted to the Cost Containment Division. No additional documentation not presented to and considered by the Cost Containment Division shall be considered by the MWCC on review, unless specifically requested by the MWCC, and no hearing or oral argument shall be allowed, unless specifically requested by the MWCC.D. The MWCC shall consider the request for review and issue a decision.E. Following the decision of the MWCC, or following the conclusion of the dispute resolution process at any stage without an appeal to the MWCC, no further audit, adjustment, refund, review, consideration, reconsideration or appeal with respect to the claim in question by the MWCC may be sought by either party.F. The costs incurred in seeking MWCC review, or in seeking compliance with an Administrative Decision rendered by the Cost Containment Director, including reasonable attorney fees, if any, may be assessed to the party who requested review if that party's position is not sustained by the MWCC and to the party who has failed to comply with a prior decision if compliance therewith is ordered by the MWCC. Otherwise, each party shall bear their own costs, including attorney's fees. G. If the Cost Containment Director and/or the MWCC determines that a dispute is based on or arises from a billing error, a payment adjustment or error, including but not limited to improper bundling of service codes, unbundling, downcoding, code shifting, or other action by either party to the dispute, or if the MWCC determines that a provider or payer has unreasonably refused to comply with the Law, the Rules of the MWCC, including this Fee Schedule, or with any decision of the MWCC or its representatives, and that this causes proceedings with respect to the billing and/or payment for covered medical services to be instituted or continued or delayed without reasonable grounds, then the MWCC may require the responsible party or parties, and/or the attorney advising such party or parties, to pay the reasonable expenses, including attorney's fees, if any, to the opposing party; and, in addition, the MWCC may levy against the responsible party or parties a civil penalty not to exceed the sum of ten thousand dollars ($10,000.00), payable to the MWCC, as provided in § 71-3-59(2) of the Law. The award of costs and penalties as herein provided shall be in addition to interest and penalty charges which may apply under other provisions of this Fee Schedule. Click here to view image