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Wisconsin Medical Fee Schedule Absence Very Expensive Option – WCRI


WCRI-Wisconsin Medical Fee Schedule Lacking

A Wisconsin medical fee schedule would likely help out the Badger State.   WCRI ( Workers Comp Research Institute) recently updated its analysis of the Workers Comp environment in Wisconsin.

state capitol wisconsin medical fee schedule wood pic
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One of the easiest ways to cut Workers Comp costs in a state is to enact a fee schedule.   I have written many posts on fee schedules as a way for  a State House and Senate to reduce A Wisconsin medical fee schedule is long overdue.   When State Representatives and Senators become Risk Managers, the results can be lacking at best.

The State of Virginia enacted a fee schedule which was surprising to me at the time.   We shall see how their medical costs change over the next few years.

However, medical fee schedules are State Government based  Risk Management at its best.  Reducing the bills upfront lets the providers know what they will be paid and allows claims staffs to better reserve the claim files accurately.

WCRI has confirmed this delineation between fee schedule and non-fee schedule states.  Their newest study on the lack of a Wisconsin Medical Fee Schedule proves my point.

A new study by the Workers Compensation Research Institute (WCRI) found that Wisconsin’s medical payments per workers’ compensation claim were higher than typical for 2015 injuries evaluated as of March 2016. While growth in Wisconsin’s workers’ compensation medical payments per claim slowed in the past several years, medical payments were still increasing at a faster rate than other states that WCRI studied.

Elkhorn wisconsin medical fee schedule Medical Center
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The study, CompScope™ Medical Benchmarks for Wisconsin, 18th Edition, examined the costs, prices, and utilization of workers’ compensation medical care in Wisconsin in comparison with 17 states.

The following are among the WCRI study findings:

  • In 2015, Wisconsin’s workers’ compensation medical payments per claim with more than seven days of lost time were 61 percent higher than the median study state; medical payments per all paid claims were 46 percent higher than typical. These results reflect a widening gap between Wisconsin and the median study state compared with prior editions of the CompScope™ report, which showed Wisconsin’s average medical payments as being closer to the median study state.
  • Substantially higher prices paid for non-hospital medical services were a factor contributing to higher average medical payments. Utilization of non-hospital medical services in Wisconsin was among the lowest of the study states.
  • Payments per claim for non-hospital services increased 3 percent annually from 2010 through 2015, driven more by price increases than utilization.
  • Similarly, hospital outpatient payments per claim increased 4.7 percent per year, on average. Increases in payments per service contributed to this trend; there was little change in utilization of hospital outpatient care.
  • In 2015, Wisconsin had among the highest percentages of claims receiving hospital outpatient care, due primarily to a higher percentage of workers receiving radiology, physical medicine, and office visits from hospital outpatient providers.


WCRI studied medical payments, prices, and utilization in 18 states, including Wisconsin, looking at claim experience through 2016 on injuries that occurred mainly in 2010 to 2015. WCRI’s CompScope™ Medical Benchmarks studies compare payments from state to state and across time.


To purchase this report, visit https://www.wcrinet.org/reports/compscope-medical-benchmarks-for-wisconsin-18th-edition.

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James J Moore - Workers Comp Expert

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Management 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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