Medical Bills U&C – Overpaying?
Are you overpaying for medical bills in U&C or a fee schedule? I posted my views on medical billing for Workers Compensation in this article.
Workers Compensation bills, of course, are processed on a usual and customary (U&C) or a fee schedule basis. There seems to be a bit of confusion among J&L’s clients and people that I talk to at conferences or when I do presentations concerning U&C bills.
Usually, when a Workers Comp medical invoice is received, it is processed with a fee schedule and then certain bill processing providers will send the bills through their Preferred Provider Networks (PPO’s). A customary discount is taken – usually 10 – 20% for the medical providers that have signed on with the PPO.
As with health insurance PPO’s the medical providers trade the PPO discount for a theoretical higher volume of patients. Some networks allow a stacking of networks which will result in even a higher discount. Some states do not allow stacking of PPO networks.
There are many derivations of the fee schedule and PPO network structures. This post would be too long if I even started to cover them all. The main area I wanted to address is the U&C bills.
There are two main instances where medical bills should be processed under U&C:
- If there are no Workers Comp fee schedules
- Medical bills other than Workers Comp (disability, health, auto, liability, etc)
The one concern that most of our clients have is the cost of processing medical bills that do not have a fee schedule. Long term or short term disability cannot be processed as Workers Comp bills. They should be processed under a U&C agreement.There are many different levels of U&C. Medical bills other than Workers Comp are usually processed using many different factors such as address, etc. The one caveat here is that U&C bills are more expensive to process.
U&C bills often are subject to a nurse review, then varying different analyses to reduce the bills. U&C bills are much more likely to be protested or negotiated. The simple process mostly used for Workers Comp bills with a fee schedule does not apply.
Almost all U&C bills are processed on a % of saving basis. This consists of the medical bill processing company charging a % of the bill reduction, not on the total bill. For instance, if a $23,000 bill was reduced to $15,000 the medical bill processor will only charge a % of the $8,000 reduction – not on the $23,000.
The bill processors we use have performed an outstanding job on U&C medical bills regardless of whether they were in a non-fee schedule Workers Comp state or if the bills were not Workers Comp. We recently added another provider that can be stacked on top of our normal medical bill processing. J&L had to search for months to find this type of processor.
Bottom Line – Are you overpaying for your medical bill processing be it Workers Comp or not? It is not very likely regardless of whether the medical bills are Workers Comp or another line of insurance. There are exceptions that you can easily spot with reports from your medical bill processor.
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