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New Virginia Medical Fee Schedule – Closer Look

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New Virginia Medical Fee Schedule Active on January 1, 2018

The new Virginia medical fee schedule for Workers Compensation commences in a few weeks.   I actually thought it would not happen for another few years.   The new Virginia medical fee schedule leaves just four states that do not have medical fee schedules.    For instance, Wisconsin has no medical fee schedule and the Badger State has some of the highest medical charges in the nation for Workers Comp.

Pic of new Virginia Medical Fee Schedule Monticello
Fopseh – Wikimedia License

I thought a visit to the Virginia Department of Workers Compensation website would be appropriate.  The fee schedule FAQ can be found here.  The file is a PDF file.

Some of the highlights from the fee schedule FAQ are:

No retroactive charges on old claims – 

When will the MFS become effective?  The regulations implementing the fee schedule shall become effective January 1, 2018 and apply to health care services provided to an injured worker for any dates of service on or after this date, regardless of the date of injury

A PPO agreement can exceed the Fee Schedule

What if the contract or network agreement reimbursement is lesser or greater than the Medical Fee Schedule for the medical services I provide? The amount agreed upon by all parties to the contract for reimbursement of fee scheduled medical service may be less than or exceed the maximum fee amount.

The PPO network does not need to be listed (? –  I think) but it should be regardless 

What if I access a preferred provider network (PPO), does it need to be listed on the EOR to be reimbursed? The MFS applies in the absence of a contract.

I am sure that WCRI (Workers Comp Research Institute) will produce very interesting numbers soon on the change.

The complete new Virginia Fee Schedule can be found here.   The new Virginia medical fee schedule will be adjusted at the end of the first year with a three month grace period.

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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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