Or. Admin. R. 436-009-0110
Current through Register Vol. 63, No. 6, June 1, 2024
Section 436-009-0110 - Interpreters(1)Choosing an Interpreter.(a) A worker may choose a person to communicate with a medical provider when the worker and the medical provider speak different languages, including sign language. The worker may choose a family member, a friend, an employee of the medical provider, or an interpreter. However, for signed language interpretation services, the worker may only choose an interpreter who is a medical sign language interpreter licensed under Oregon Laws 2023, chapter 414, section 6. A representative of the worker's employer may not provide interpreter services. The medical provider may disapprove of the worker's choice at any time the medical provider feels the interpreter services are not improving communication with the worker, or feels the interpretation is not complete or accurate.(b) When a worker asks an insurer to arrange for interpreter services, the insurer must: (A) For interpretation services, other than signed language interpretation services, use a certified or qualified health care interpreter listed on the Oregon Health Care Interpreter Registry of the Oregon Health Authority available at: http://www.oregon.gov/OHA/OEI/Pages/HCI-Program.aspx. The interpreter's certification or qualification must be in effect on the date the interpreter services are provided. If no certified or qualified health care interpreter is available, the insurer may schedule an interpreter of its choice subject to the limits in subsection (a) of this section.(B) For signed language interpretation services, use a sign language interpreter licensed under Oregon Laws 2023, chapter 414.(2)Billing.(a) Interpreters must charge the usual fee they charge to the general public for the same service.(b) Interpreters may only bill an insurer or, if provided by contract, a managed care organization (MCO). However, if the insurer denies the claim, interpreters may bill the worker.(c) Interpreters may bill for interpreter services and for mileage when the round-trip mileage is 15 or more miles. For the purpose of this rule, "mileage" means the number of miles traveling from the interpreter's starting point to the exam or treatment location and back to the interpreter's starting point.(d) If the interpreter arrives at the provider's office for an appointment that was required by the insurer or the director, e.g., an independent medical exam, a physician review exam, or an arbiter exam, the interpreter may bill for interpreter services and mileage according to section (2)(c) of this rule even if: (A) The worker fails to attend the appointment; or(B) The provider has to cancel or reschedule the appointment.(e) If interpreters do not know the workers' compensation insurer responsible for the claim, they may contact the division at 503-947-7814. They may also access insurance policy information at http://www4.cbs.state.or.us/ex/wcd/cov/index.cfm.(3)Billing and Payment Limitations.(a) When an appointment was not required by the insurer or director, interpreters may not bill any amount for interpreter services or mileage if the provider cancels or reschedules the appointment.(b) Other than missed appointments for arbiter exams, director required medical exams, independent medical exams, worker requested medical exams, and closing exams, an interpreter may bill a workers' compensation client if the client fails to attend the appointment and if:(A) The interpreter has a written missed-appointment policy that applies not only to workers' compensation clients, but to all clients;(B) The interpreter routinely notifies all clients of the missed-appointment policy;(C) The interpreter's written missed-appointment policy shows the cost to the client; and(D) The client has signed the missed-appointment policy.(c) The implementation and enforcement of subsection (b) of this section is a matter between the interpreter and the client. The division is not responsible for the implementation or enforcement of the interpreter's policy.(d) The insurer is not required to pay for interpreter services or mileage when the services are provided by:(A) A family member or friend of the worker; or(B) A medical provider's employee.(4)Billing Timelines.(a) Interpreters must bill within: (A) 60 days of the date of service;(B) 60 days after the interpreter has received notice or knowledge of the responsible workers' compensation insurer or processing agent; or(C) 60 days after any litigation affecting the compensability of the service is final, if the interpreter receives written notice of the final litigation from the insurer.(b) If the interpreter bills past the timelines outlined in subsection (a) of this section, the interpreter may be subject to civil penalties as provided in ORS 656.254 and OAR 436-010-0340.(c) When submitting a bill later than outlined in subsection (a) of this section, an interpreter must establish good cause.(d) A bill is considered sent by the date the envelope is post-marked or the date the document is faxed.(5)Billing Form.(a) Interpreters must use an invoice when billing for interpreter services and mileage and use Oregon specific code: (A) D0004 for interpreter services, excluding American Sign Language interpreter services, provided by noncertified interpreters;(B) D0005 for American Sign Language interpreter services;(C) D0006 for interpreter services, excluding American Sign Language interpreter services, provided by a health care interpreter certified by the Oregon Health Authority; and(b) An interpreter's invoice must include: (A) The interpreter's name, the interpreter's company name, if applicable, billing address, and phone number;(C) The worker's workers' compensation claim number, if known;(D) The correct Oregon specific codes for the billed services (D0004, D0005, D0006, or D0041);(E) The workers' compensation insurer's name and address;(F) The date interpreter services were provided;(G) The name and address of the medical provider that conducted the exam or provided treatment;(H) The total amount of time interpreter services were provided; and(I) The mileage, if the round trip was 15 or more miles.(6)Payment Calculations.(a) Unless otherwise provided by contract, insurers must pay the lesser of the maximum allowable payment amount or the interpreter's usual fee.(b) Insurers must use the following table to calculate the maximum allowable payment for interpreters: [See attached table.](7)Payment Requirements.(a) When the medical exam or treatment is for an accepted claim or condition, the insurer must pay for interpreter services and mileage if the round-trip mileage is 15 or more miles.(b) When the worker fails to attend or the provider cancels or reschedules a medical exam required by the director or the insurer, the insurer must pay the no-show fee and mileage if the round-trip mileage is 15 or more miles.(c) The insurer must retain the invoice and pay the interpreter within: (A) 14 days of the date of claim acceptance or any action causing the service to be payable, which includes receiving a bill for or chart note of the corresponding medical appointment, or 45 days of receiving the invoice, whichever is later; or(B) 45 days of receiving the invoice for an exam required by the insurer or director.(d) When an interpreter bills within 12 months of the date of service, the insurer may not reduce payment due to late billing.(e) When an interpreter bills over 12 months after the date of service, the bill is not payable, except when a provision of subsection (4)(c) of this rule is the reason the billing was submitted after 12 months.(f) If the insurer does not receive all the information to process the invoice, other than a bill for or chart note of the corresponding medical appointment, the insurer must return the invoice to the interpreter within 20 days of receipt. The insurer must provide specific information about what is needed to process the invoice.(g) When there is a dispute over the amount of a bill or the appropriateness of services rendered, the insurer must, within 45 days, pay the undisputed portion of the bill and at the same time provide specific reasons for nonpayment or reduction of each service billed.(h) The insurer must provide a written explanation of benefits for services paid or denied and must send the explanation to the interpreter that billed for the services. If the billing is done electronically, the insurer or its representative may provide this explanation electronically. All the information on the written explanation must be in 10 point size font or larger.(i) Electronic and written explanations must include:(A) The payment amount for each service billed. When the payment covers multiple workers, the explanation must clearly separate and identify payments for each worker;(B) The specific reason for nonpayment, reduced payment, or discounted payment for each service billed;(C) An Oregon or toll-free phone number for the insurer or its representative, and a statement that the insurer or its representative must respond to an interpreter's payment questions within two days, excluding Saturdays, Sundays, and legal holidays;(D) The following notice, Web link, and phone number: "To access the information about Oregon's Medical Fee and Payment rules, visit www.oregonwcdoc.info or call 503-947-7606";
(E) Space for a signature and date; and(F) A notice of the right to administrative review as follows: "If you disagree with this decision about this payment, please contact {the insurer or its representative} first. If you are not satisfied with the response you receive, you may request administrative review by the Director of the Department of Consumer and Business Services. Your request for review must be made within 90 days of the mailing date of this explanation. To request review, sign and date in the space provided, indicate what you believe is incorrect about the payment, and mail this document with the required supporting documentation to the Workers' Compensation Division, Medical Resolution Team, PO Box 14480, Salem, OR 97309-0405. Or you may fax the request to the director at 503-947-7629. You must also send a copy of the request to the insurer. You should keep a copy of this document for your records."
(G) Effective no later than October 1, 2024, the notice listed under paragraph (F) of this subsection must be replaced with the following notice in bold text and formatted as follows: If you disagree with this decision about payment, contact {the insurer or its representative} first. If you still disagree about payment, you may request administrative review by the Department of Consumer and Business Services (DCBS). To request review, you must do all of the following:
- Submit your request within 90 days of the mailing date of this explanation
- Sign and date this explanation in the space provided
- Explain why you think the payment is incorrect
- Attach required supporting documentation of your expense
- Send the documents to:
DCBS Workers' Compensation Division
Medical Resolution Team
350 Winter Street NE
PO Box 14480
Salem OR 97309-0405
Or
Fax your request to the Medical Resolution Team at 503-947-7629
- Send a copy of your request to the insurer
Keep a copy of this document for your records.
(j) The insurer or its representative must respond to an interpreter's inquiry about payment within two days, excluding Saturdays, Sundays, and legal holidays. The insurer or its representative may not refer the interpreter to another entity to obtain the answer.(k) The insurer or its representative and an interpreter may agree to send and receive payment information by email or other electronic means. Electronic records sent are subject to the Oregon Consumer Information Protection Act under ORS 646A.600 to 646A.628 and federal law.Or. Admin. R. 436-009-0110
WCD 3-2010, f. 5-28-10, cert. ef. 7-1-10; WCD 1-2012, f. 2-16-12, cert. ef. 4-1-12; WCD 2-2013, f. 3-11-13, cert. ef. 4-1-13; WCD 3-2014, f. 3-12-14, cert. ef. 4-1-14; WCD 3-2015, f. 3-12-15, cert. ef. 4/1/2015; WCD 1-2016, f. 3-7-16, cert. ef. 4/1/2016; WCD 1-2017, f. 3-6-17, cert. ef. 4/1/2017; WCD 5-2018, amend filed 03/15/2018, effective 4/1/2018; WCD 2-2019, amend filed 03/11/2019, effective 4/1/2019; WCD 4-2020, amend filed 03/04/2020, effective 04/01/2020; WCD 2-2022, amend filed 03/02/2022, effective 4/1/2022; WCD 4-2023, amend filed 11/22/2023, effective 1/1/2024; WCD 1-2024, amend filed 03/05/2024, effective 4/1/2024Statutory/Other Authority: ORS 656.726(4)
Statutes/Other Implemented: ORS 656.245 & ORS 656.248