Haw. Code R. § 12-15-80

Current through August, 2024
Section 12-15-80 - Reports of providers of service
(a) Any provider of service required by chapter 386, HRS, this chapter, or any related rules to make and submit reports of an injury and treatment shall:
(1) Submit those reports to the director and the self-insured employer, or the insurer of the employer when the employer is not self-insured, whichever is applicable; and
(2) Itemize its statement of services rendered in a manner showing the date of injury, diagnosis, date of each visit or service, the appropriate code number used as the basis for the charge, and the fee not to exceed the maximum allowed under the medical fee schedule. No service charge for preparing and submitting reports required by section 386-96, HRS, and any related rules shall be allowed.
(3) Interim WC-2 reports shall be submitted monthly with the corresponding billing invoice, if applicable, to the employer and shall include the following:
(A) Current diagnosis and prognosis;
(B) Complete information as to the nature of the examination(s) and treatments performed, dates of those treatments, and the results obtained within the current reporting period;
(C) A complete listing of all tests performed within the current reporting period and the results of the tests;
(D) A statement of whether the injured employee is improving, worsening, or if "medical stabilization" has been reached; and
(E) Dates of disability, work restrictions, if any, and return to work date.
(4) When an injured employee is returned to full-time, regular, light, part-time, or restricted work, the attending physician shall submit a report to the employer within seven calendar days indicating the date of release to work or medical stabilization.
(b) Interim WC-2 reports and all medical documentation shall be submitted by the employer to the director upon submission of a "Request For Hearing" or within ten calendar days of a request by the director. Any party who fails to furnish medical reports within ten calendar days after being requested by the director may be subject to penalties pursuant to section 386-97.5, HRS.
(c) The repeated failure of a physician, surgeon, hospital, or provider of service to comply with chapter 386, HRS, and any related rules shall be a reasonable basis for an employer to refuse to pay or withhold payment for services rendered.

Haw. Code R. § 12-15-80

[Eff 1/1/96; am 11/22/97; am 12/17/01; am 12/13/04] (Auth: HRS §§ 386-26, 386-27, 386-72) (Imp: HRS §§ 386-21, 386-26, 386-27, 386-96)