Nevada § 616C.260 - Fees and charges for accident benefits: Restrictions; establishment and revision of schedule; powers and duties of Administrator; administrative penalty for refusal to provide information; regulations

§ 616C.260. Fees and charges for accident benefits: Restrictions; establishment and revision of schedule; powers and duties of Administrator; administrative penalty for refusal to provide information; regulations

1. All fees and charges for accident benefits must not: (a) Exceed the amounts usually billed and paid in the State for similar treatment. (b) Be unfairly discriminatory as between persons legally qualified to provide the

particular service for which the fees or charges are asked. 2. The Administrator shall, giving consideration to the fees and charges being billed

and paid in the State, establish a schedule of reasonable fees and charges allowable

for accident benefits provided to injured employees whose insurers have not contracted

with an organization for managed care or with providers of health care pursuant to NRS 616B.527 . The Administrator shall review and revise the schedule on or before February 1 of

each year. In the revision, the Administrator shall adjust the schedule by the corresponding

annual change in the Consumer Price Index, Medical Care Component. 3. The Administrator shall designate a vendor who compiles data on a national basis

concerning fees and charges that are billed and paid for treatment or services similar

to the treatment and services that qualify as accident benefits in this State to provide

the Administrator with such information as the Administrator deems necessary to carry

out the provisions of subsection 2. The designation must be made pursuant to reasonable competitive bidding procedures

established by the Administrator. In addition, the Administrator may request a health insurer, health maintenance

organization or provider of accident benefits, an agent or employee of such a person,

or an agency of the State to provide the Administrator with information concerning

fees and charges that are billed and paid in this State for similar services as the

Administrator deems necessary to carry out the provisions of subsection 2. The Administrator shall require a health insurer, health maintenance organization

or provider of accident benefits, an agent or employee of such a person, or an agency

of the State that provides records or reports of fees and charges billed and paid

pursuant to this section to provide interpretation and identification concerning the

information delivered. The Administrator may impose an administrative fine of $500 on a health insurer,

health maintenance organization or provider of accident benefits, or an agent or employee

of such a person for each refusal to provide the information requested pursuant to

this subsection. 4. The Division may adopt reasonable regulations necessary to carry out the provisions

of this section. The regulations must include provisions concerning: (a) Standards for the development of the schedule of fees and charges that are billed

and paid; and (b) The monitoring of compliance by providers of benefits with the schedule of fees

and charges. 5. The Division shall adopt regulations requiring the use of a system of billing codes

as recommended by the American Medical Association.