D.C. Mun. Regs. tit. 7, § 125
125.1 After the employee's first appointment with a treating physician, the physician shall file Form 3 or a comprehensive medical report with the Program containing a diagnosis of physical findings or examination, a statement concerning the injury's relationship to employment, the treatment plan, if any, an opinion regarding the employee's prognosis, and nature and extent of disability, within ten (10) business days of an examination of the injured employee.
125.2 The following information shall be included in Form 3 or medical reports from a physician that are used by the Program in connection with an ID, ED, or other Program decision affecting an employee's claim or claimant's benefits:
diagnosed condition(s) and the original work-place injury and resulting condition(s);
(n) Nature, extent, and expected duration of disability affecting the employee's ability to work due to the injury;
(o) Prognosis for recovery, including an estimate regarding when the claimant will be able to return to work; and
(p) All other material findings.
125.3 Any physician who continues to treat an injured employee or claimant shall, at no cost, provide medical reports, treatment records, and bills to the Program, no later than ten (10) days after medical examination or treatment is received.
125.4 All medical providers shall include in each medical report and bill for services rendered under the Act, the code, as published by the American Medical Association (AMA) in the most current edition of the Physicians Current Procedural Terminology (CPT Codes), for detailing the billing of all medical procedures and the codes established by the most recent edition of the International Classification of Diagnosis (ICD) code, as published by the U.S. Department of Health and Human Services, for diagnosing the conditions.
125.5 All medical providers shall provide invoices with Form 3 or medical reports to substantiate payment of bills. All reports shall be typewritten on the medical provider's letterhead and signed and dated by the attending physician and include information required under § 125.2 and adhere to the standards provided at § 137.3.
125.6 To be considered for payment, bills must be submitted by the end of the calendar year after the year when the expense was incurred, or by the end of the calendar year after the year when the Program first accepted the claim as compensable, whichever is later.
125.7 Fees and other charges for treatment or medical services shall be limited to those that are authorized by the schedule pursuant to § 126.2 or, if not reflected in the schedule, are reasonable and customary charges prevailing in the local medical community as the Program determines.
125.8 The cost of physical examinations ordered by the Program shall be paid by the Program, unless the examination is conducted by a non-panel physician. A panel physician shall not attempt to collect a disputed payment for medical services in connection with a compensable claim under the Act from the injured employee or claimant.
SOURCE: Final Rulemaking published at 28 DCR 2307 (May 22, 1981); as amended by Emergency and Proposed Rulemaking published at 57 DCR 9540 (October 8, 2010)[EXPIRED]; as amended by Final Rulemaking published at 57 DCR 12224, 12229 (December 24, 2010); as amended by Final Rulemaking published at 59 DCR 8766, 8771 (July 27, 2012); as amended by Final Rulemaking published at 64 DCR 6325 (July 7, 2017).