Medical Cost Containment
The Medical Cost Containment Bureau (MCC) is responsible for assisting in the delivery of appropriate, timely, efficient and cost-effective medical care to injured workers in New Mexico. The MCC plays a vital role in developing and enhancing the annual Health Care Providers’ Fee Schedule and Billing Instructions. The MCC also is responsible for resolving medical billing disputes as well as the oversight of Nurse Case Management and Utilization Review requests.
The MCC supports two key committees—the Independent Medical Examiners (IME) and the Directors’ Medical Advisory Committee (DMAC) to address workers’ compensation issues, concerns, and fee schedules.
General Email
Bureau Chief
Catherine Sanchez
MCC Bureau Chief
(505) 841-6042
Catherine.Sanchez@wca.nm.gov
Independent Medical Examiners (IME)
Independent Medical Examinations (IMEs) are neutral medical exams provided in certain workers’ compensation cases when parties dispute a worker’s medical treatment or medical issues need clarification. IMEs can be performed by a single physician or a panel of physicians and specialists.
Either party may petition a workers’ compensation judge for the worker to be examined by an independent physician(s) who has not previously treated the worker. IMEs can also occur by agreement of the parties. The judge then considers the opinion of that examination in determining the case. IME providers in New Mexico must be licensed health care providers in good standing and must use the most recent American Medical Association’s (AMA) Guide (the Guides) to the Evaluation of Permanent Impairment.
IME providers used by a judge must be on the WCA IME provider list, which is approved by the IME Provider Selection Committee and reviewed/revised annually, with the review period open from March 1 through May 31. The committee members represent both labor and industry and are appointed by the WCA Advisory Council.
Directors’ Medical Advisory Committee (DMAC)
The Director’s Medical Advisory Committee (DMAC) advises the WCA on medical treatment guidelines, fee schedules, and health care regulations to align with injured workers’ best interests and the goals of the workers’ compensation system.
Health Care Provider (HCP) Fee Schedules and Billing Instructions
The WCA’s Medical Cost Containment Bureau implements various cost-saving measures for medical services provided to injured or disabled workers. The MCC Bureau, in conjunction with the Economic Research and Policy Bureau, publishes the Health Care Provider Fee Schedule (HCP Fee Schedule) and Billing instructions to set costs for medical procedures. Health care providers are normally limited to receiving payments within the range of the Fee Schedule.
Hospital Ratios
For the method of payment for Freestanding Ambulatory Surgery Centers, please refer to the Free-Standing Ambulatory Surgery Center section of the Fee Schedule and Billing Instructions. Current hospital ratios can be found in the Hospital Ratios section of the Fee Schedule and Billing Instructions effective January 1st of this year.