Document name
Hospitals and Other Treating Centres
Document number
PRO 55/2010

Effective date: November 1, 2010

Application: All claims requiring out-patient/in-patient services and high cost procedures.

Policy subject: Health care services – Providers

Purpose:

To establish hospital per diem out-patient/in-patient rates and high cost procedures billing.

DEFINITIONS

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High Cost Procedures means medical aid provided in a hospital or treatment facility involving highly trained physicians and advanced technology (e.g., organ transplants).

BACKGROUND

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POL 02/1997, Health Care Service Fees, authorizes the Chief Executive Officer to negotiate and administer fees for medical aid furnished by any health care professional.

PROCEDURE

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  1. The Workers’ Compensation Board (WCB) will reimburse any hospital or treatment facility for out-patient and in-patient services, as well as high cost procedures, in accordance with the annual rates set by Saskatchewan Ministry of Health’s Medical Services Branch (MSB), except where an alternate contract exists.
  2. Services not established under the MSB rates will be paid according to the WCB rates negotiated for their discipline.
  3. The WCB Finance Department will be responsible for ensuring that the most current rates set by the MSB are used. Rate adjustments will be applied retroactively to the effective date set by the MSB.
  4. Only hospital services and procedures that are directly necessary in the treatment of a worker’s compensable injury will be paid for by the WCB.

Policy references

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Act Sec #

Page/document title
103, 104, 109(b)

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Supersedes

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PRO 03/98 Repeal of Medical Fees – Wascana Outpatient
PRO 64/1999 Medical Fees – Hospital Out-Patient & High Cost Procedures Billing Rates
PRO 65/1999 Medical Fees – Hospital Per-Diem In-Patient
PRO 102/2002 Medical Fees – Hospital Per-Diem In-Patient Rate
 

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Complements

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