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Workers Comp Fee Schedules – Follow Up To My Last Post

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Workers Comp Fee Schedules As Cost Controllers

Workers Comp fee schedules are one of the best ways for a state to help employers control WC costs.

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Yesterday, I posted an article on the new NCCI study on fee schedules.  After talking with a few prognosticators in the health insurance and WC fields, I think I may have been reading the title of the NCCI study incorrectly.

I decided to pull 30 random physician bills in fee-schedule states (approximately 30) from some of the files that we are reviewing. Some of the physician bills had in-network reductions after the fee schedule was applied to the charges. The results of my quick study were:

 Total physician charges of all bills  before fee schedule (surgical and non-surgical)   $24,876

Total physician bills after fee schedule                                                                    $13,958

Total physician bills after in-network reduction (post fee schedule)                         $13,026

Total savings from fee schedule and in-network                                                     $11,850

Estimation of what health insurer would have paid                                          $  9,284

WCRI (Workers Comp Research Institute) had performed a massive study on health vs. Workers Comp payments for outpatient shoulder surgery.   This study left no doubt that WC treatment is much more expensive than health.   

Could it be that health insurer networks provide a higher volume than WC therefore the physicians are willing to concede more charges?

Analyzing the complexities of how health insurers reimburse medical treatment is something that I do not do as health insurance is not one of my specialties.

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Workers Comp fee schedule articles that I have written and are still applicable:

There are many more articles that can be found on fee schedules by using the search box and typing in WCRI, NCCI, or fee schedule.  Feel free to print them.

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James Moore

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications

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