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Home » fee schedule

Workers Comp Outpatient Medical Costs – Fee Schedules Win Again

May 14, 2020 By JL Risk Management Consultants

States With Fee Schedules Have Lower Workers Comp Outpatient Medical Costs – WCRI

Fee schedules have appeared in this blog many times due to the economic effects they have on medical bills.   WCRI (Workers Comp Research Institute) published a study this week showing that fee schedules lower Workers Comp outpatient medical costs.   The study specifically covered hospital outpatient costs. 

picture of 100 dollar bill workers comp outpatient medical

Copyright Public Domain US Treasury

The outpatient medical cost study is produced by WCRI yearly.   We here at J&L watch for this study every year as a bellwether for fee schedules versus the other billing methods.  

We liked the depth of the study – 13 years for you triskaidekaphobia sufferers. 

The study, the latest in an annual series, compares hospital payments for a group of common outpatient surgeries in workers’ compensation across 36 states from 2005 to 2018.

Let us look at these numbers.  The increased charges remain outstandingly high each year this study is published.   The name of the study is the Hospital Outpatient Payment Index: Interstate Variations and Policy Analysis, 9th Edition.  

 WCRI came to two astounding conclusions (are you ready for these numbers?).  The two researchers Dr. Formenko and Dr. Yang.  They split the numbers between % of charge-based states and states without any fee schedule.  

  • Percent-of-charge-based fee regulations were 74 to 168 percent higher than the median of the study states with fixed-amount fee schedules in 2018.
  • No fee schedules, they were 51 to 131 percent higher.
  • WCRI also found that hospital outpatient payments per episode in most states with percent-of-charge-based fee regulations or no fee schedules grew faster than in states with fixed-amount fee schedules.

Variation in the difference between average workers’ compensation payments and Medicare rates for a common group of procedures across states was even greater — reaching as low as 42 percent (or $2,574) below Medicare in Nevada and as high as 365 percent (or $17,713) above Medicare in Alabama.

This means that when using the most stable statistic among the states (Medicare rates), the statistic the hospitals have a workers comp outpatient medical cost variance of $20,287. 

Overall, the figures show a 50% difference between fee schedules states and states without them. 

Often Unmentioned Fee Schedule Benefit 

Setting medical reserves can easily confound the most experienced claims adjuster or supervisor.   States with fee schedules lessen the inaccuracy of setting medical reserves.  Some adjusters use old fee scheduled bills to compare procedure costs.  (secret shortcut). 

After 10 years of experience, most adjusters and supervisors more easily develop a sixth sense of how much a medical procedure costs in states with fee schedules.  

Workers Comp Outpatient Medical Excluded Data and States Covered 

Male Doctor of workers comp outpatient medical analyzing x-ray report

StockUnlimited

This study captures payments for services provided and billed by hospitals; it excludes professional services billed by nonhospital medical providers (such as physicians, physical therapists, and chiropractors) and transactions for durable medical equipment and pharmaceuticals billed by providers other than hospitals. The analysis also excludes payments made to ambulatory surgery centers.

Go here for more info and to download the study.

The 36 states included in this study are Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, West Virginia, and Wisconsin.

 

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Filed Under: fee schedule Tagged With: ambulatory surgery centers, chiropractors, interstate variations, nonhospital medical, outstandingly high, triskaidekaphobia sufferers

Medical Fee Schedule Dilemma – WCRI Study – High Cost States Have None

May 31, 2019 By JL Risk Management Consultants

Medical Fee Schedule Dilemma – No Schedule Means Higher Costs Now and In Future

The WCRI (Workers Compensation Research Institute) just released a study pointing out a medical fee schedule dilemma.   The states that still hold on to the old U&C (Usual and Customary) method of charging for workers’ compensation treatment are costing employers dearly.  

picture of medical fee schedule dilemma dollar sign

Public Use License – Trianthom

According to the WCRI – 

The study, WCRI Medical Price Index for Workers’ Compensation, 11th Edition (MPI-WC), found that prices paid in states with no fee schedules for professional services were 39 to 171 percent higher than the median of the study states with fee schedules in 2018. WCRI also found that medical prices in most states with no fee schedules grew faster than in states with fee schedules — the median growth rate among the non-fee schedule states was 34 percent from 2008 to 2018, compared with the typical growth rate of 6 percent among the fee schedule states. 

OK, so let us look at what WCRI has proffered in this study. 

  • At a minimum, the services were 39% higher in states with the medical fee schedule dilemma.
  • Some states are priced at 171% higher.
  • The non-fee schedule states’ medical costs grew at an almost 600% faster rate.  

I have not fully read the study.  I have written on fee schedules so many times that if you go to the bottom of this article and click on the category fee schedule, you will have more than enough material to assess whether a medical fee schedule saves employers premiums and self insureds their insurance budgets. 

Look a the bolded numbers again.   Those are not small numbers.   States such as Tennessee, Indiana, and Virginia have all decided to take the plunge and enact fee schedules.   What do you think happened to those states’ medical costs for workers’ compensation?   Yes, they have reduced their spending.

WCRI Comprehensive Study Details

This annual report focuses on professional services billed by physicians, physical therapists, and chiropractors. The medical services fall into eight groups: evaluation and management, physical medicine, surgery, major radiology, minor radiology, neurological and neuromuscular testing, pain management injections, and emergency care.

The 36 states in the study, which represent 88 percent of the workers’ compensation benefits paid in the United States, are Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Wisconsin.

Get Your Free, yes freebies copy here.

I am going to read the study over the weekend and report back on it next week to see which states actually are having a workers’ comp medical fee schedule dilemma. 

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Filed Under: fee schedule Tagged With: chiropractors, dilemma, MPI-WC, neuromuscular, radiology

WCRI Chart ASCs vs. Hospitals Shows Interesting 18 State Comparison

December 14, 2018 By JL Risk Management Consultants

WCRI Chart On ASC Studies Shows Need For Fee Schedules in Workers Compensation

A recent WCRI Chart (Workers Compensation Research Institute) pointed out a hidden result that was picked up at least partially by a few bloggers.  The chart below comes from a study the WCRI released on November 25th.  

WCRI Chart ASC Hospital Comparison 18 State Study

(c) WCRI – Boston MA

An attempt was made to make the chart as readable as possible.   Two areas came to light after examining this WCRI chart.   Two anomalies – one more pronounced than the other – became apparent very quickly.   

  • Wisconsin, Virginia, and Lousiana all had outpatient hospital fees above $10,000 
  • Indiana had ASC fees that were significantly above the outpatient hospital fees – a very rare occurrence 

According to the WCRI article, the end of the study period was in 2016.  The particulars of the study and how to access the study are provided later in this article. 

For reference – ASC is the acronym for Ambulatory Surgical Centers – standalone surgical centers. 

Hospital Outpatient Fees > $10,000

The comparison WCRI chart data, therefore, included no data after Virginia enacted their fee schedule.  Wisconsin still has no fee schedule.   Virginia decided to institute a fee schedule after 2016.    No fee schedule causes more payouts for medical treatment.   (Why?)

The Workers Comp systems in Virginia and Wisconsin base their costs and Usual and Customary – the acronym is U&C.   No set payment can be anticipated by the  Workers Compensation carriers or self-insurers in those two states. 

The charges for outpatient surgeries can only be estimated with an educated guess.  Usually, hospital outpatient centers  (as most medical providers) do not post what the cost of surgery will be until the bill is received by the carrier.  

Indiana’s Expensive ASCs

The WCRI chart indicates ASCs are usually the same as or less expensive than the hospital-based outpatient surgery centers.  Indiana tallies a large increase in ASC costs over hospital outpatient surgery centers.  (Why?) 

Once again, as in the above example  – in 2016 Indiana had no workers compensation fee schedule.  The ASCs reverted back to the U&C charges and billed workers comp payors at much higher rates than even the outpatient hospital surgical centers which are normally much higher than ASCs. 

Virginia’s New Fee Schedule

Once the Virginia fees schedule kicks in, their place in the most expensive hospital-based outpatient surgical center fees should reduce by more than a nominal amount.   

I am not sure if Virginia included outpatient hospital fees in their new fee schedule.  

WCRI Study Info 

You can read more about the study at this link   If you are involved in any way with workers compensation medical payments, I recommend reading the article.   The preceding link also provides info on how to obtain a copy of the study that generated the very telling WCRI chart. 

 

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Filed Under: fee schedule, WCRI Tagged With: ASC fees, Indiana tallies, nominal amount, standalone surgical centers, U&C

Workers Compensation Fee Schedules Win Again – WCRI’s Free Study

June 19, 2018 By JL Risk Management Consultants

Workers Compensation Fee Schedules = Less Costly Claims and Premiums

Virtually all Workers Compensation Fee Schedules cut comp costs across the board.   Check out this search for  fee schedules articles on this website.   WCRI  just published a massive study on workers compensation fee schedules.   The study covers 87% of the workers comp benefits paid  in the US. 

pic of student studying workers compensation fee schedules

Public Use License Wikimedia Gnarlycraig

WCRI Says Freebies On This One 

Dr. Rebecca Yang and Dr. Olesya Fomenko’s extremely comprehensive study covers 35 states.   These two researchers are data geniuses along with all the staff at WCRI.   

For many years (over 11) I have written numerous articles on fee schedules.  Why?- because they are governmental interventions that usually totally works to reduce the cost to employers, carriers, and all other parties.   Next week,  I will cover the hidden side of fee schedules that are just as important. 

Virginia just enacted a fee schedule.  For some reason, I thought Virginia would never have a fee schedule.  Some tweaks will likely be needed for their fee schedule. 

From the WCRI press release and website:

The study, WCRI Medical Price Index for Workers’ Compensation, 10th Edition (MPI-WC), compares medical prices paid in 35 states and tracks price changes in most states over a 10-year span from 2008 to 2017 for professional services billed by physicians, physical therapists, and chiropractors. The medical services fall into eight groups: evaluation and management, physical medicine, surgery, major radiology, minor radiology, neurological testing, pain management injections, and emergency care.

One interesting development pointed out by WCRI is the following states had major fee schedule changes:

  • Arizona
  • California
  • Colorado
  • Illinois
  • Kentucky
  • Massachusetts
  • North Carolina
  • Texas.
Woman workers compensation fee schedules using computer

by StockUnlimited

The rating bureaus such as NCCI (most of nation) and WCIRB (California) both provided numerous articles on fee schedules reducing costs.  

The following is a sample of the WCRI study’s findings: (directly from their website) 

  • Prices paid for a similar set of professional services varied significantly across states, ranging from 26 percent below the 35-state median in Florida to 158 percent above the 35-state median in Wisconsin in 2017.
  • States with no fee schedules for professional services had higher prices paid compared with states with fee schedules—39 to 168 percent higher than the median of the study states with fee schedules in 2017.
  • Changes in prices paid for professional services exhibited variation across states, spanning between a 17 percent decrease in Illinois and a 39 percent increase in Wisconsin over the time period from 2008 to 2017.
  • Most states with no fee schedules experienced faster growth in prices paid for professional services compared with states with fee schedules—the median growth rate among the non-fee schedule states was 30 percent from 2008 to 2017, compared with the median growth rate of 6 percent among the fee schedule states. 

I think we can draw a direct conclusion from the studies by NCCI, WCIRB, and especially WCRI.   States can only help themselves by enacting and properly adjusting their workers compensation fee schedules. 

 

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Filed Under: fee schedule Tagged With: chiropractors, interventions, neurological, physical therapists, radiology

New Virginia Medical Fee Schedule – Closer Look

November 29, 2017 By JL Risk Management Consultants

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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Filed Under: fee schedule, Virginia Tagged With: Badger State, EOR, FAQ, MFS

Wisconsin Medical Fee Schedule Absence Very Expensive Option – WCRI

November 8, 2017 By JL Risk Management Consultants

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

Public Media License

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

Wikimedia Creative Commons

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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Filed Under: fee schedule, Wisconsin Tagged With: CompScope, non-hospital, radiology, State House

Virginia Medical Fee Schedule Now Reality After Decade

June 27, 2017 By JL Risk Management Consultants

Virginia Medical Fee Schedule Finally Enacted

The lack of a Virginia Medical Fee Schedule has long been a concern of mine and many of the Dominion State’s employers.   Fee schedules do save a large amount of Workers Comp dollars while still ensuring that injured employees receive the best medical care possible. 

medical billing Virginia Workers Comp Fee Schedule Infographic

Wikimedia Commons – Dynamas2002

I covered the lack of a Virginia medical fee schedule in a number of articles.  Some of the articles were:

  • Virginia Medical Fee Schedule Hell May Freeze Over After All
  • Lack of Virginia Fee Schedule Expensive for Employer – WCRI
  • Virginia Rule 14 – Is It A Fee Schedule 

WCRI  (Workers Compensation Research Institute) and NCCI agree that Medical Fee Schedules Reduce Costs.   Some of the Virginia articles from those two organizations are:

  • Medical Fee Schedules – 43 State WCRI Report
  • Virginia’s Decision on Medical Fee Schedules -Do Nothing Cost Employers Extra 13%
  • Virginia Has The Highest Medical Cost Per Claim

The Virginia Workers Compensation Commission:

Hand Presenting Virginia Medical Fee Schedule People Icon Around The Small Globe

StockUnlimited

HB378  Workers’ compensation; fee schedules for medical services directs the Workers’ Compensation Commission to adopt regulations establishing fee schedules setting the maximum pecuniary liability of the employer for medical services provided to an injured person pursuant to the Virginia Workers’ Compensation Act, in the absence of a contract under which the provider has agreed to accept a specified amount for the medical service. The regulations implementing the fee schedules shall become effective on January 1, 2018.

If one wants to read about the full Virginia Fee Schedule timeline, click here. 

According to the Summary on HB378, some of the concerns on the Virginia Fee Schedule are:

  • PPO Networking Stacking 
  • The required reimbursement will be 100 percent of the provider’s charges if the employer unsuccessfully contests the compensability of the claim.
  • Pharmaceutical and Durable Medical Equipment Costs 

Sometime in 2019, I will publish an article on the effects of HB378.  

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Filed Under: fee schedule, Virginia Tagged With: HB 378, pharmaceutical

Is New Virginia Rule 14 Work Comp Fee Schedule?

November 4, 2015 By JL Risk Management Consultants

The New Virginia Rule 14 – Fee Schedule Soon?

The new State of Virginia Rule 14 is now closed for comments.   A copy of the Proposed Rule 14 can be found here.  (PDF File).

Adobe PDF Virginia rule 14 Logo

Wikimedia Commons – Adobe

According to the Virginia Workers Compensation Commission, a public hearing on Virginia Rule 14 was held on October 13, 2015.   The slides from the Rule 14 presentation can be found here.  Unfortunately, the deadline for comments was October 15, 2015.

I have always been a proponent of full state fee schedules.   Virginia has community rates, but not a true statewide fee schedule.   A 10 community rate basis is part of the new rule.   Check out the new regions in Virginia map below – (c) MC Innovations

As a side note, the Virginia Workers Compensation Commission’s webpage on medical charges is as follows:

Outside view of Virginia rule 14 capitol

Wikimedia Commons – Analogue Kid

The Act also provides the standard that is to be used in calculating reimbursement.Va. Code §65.2-605 states that the employer’s liability for medical charges is limited to “such charges as prevail in the same community for similar treatment[.]” The term “community” is defined by reference to Commission Rule 14. There is no fee schedule in Virginia. Charge schedules agreed to by the carrier and provider will be enforced.

If a dispute arises as to reimbursement for a medical charge, the health care provider may invoke one or more of the following remedies:

Adjudication Requirements

  • Appropriate where there has been no payment or where provider is dissatisfied with level of reimbursement
  • Initial decision issued by a deputy commissioner after reviewing evidence
  • Right of review by the Commission
  • Appeals to Virginia Court of Appeals and Supreme Court of Virginia
  • Initiated by filing a request along with supporting evidence to the Commission

The result of no fee schedule will be further analyzed tomorrow along with a study from WCRI.  Rarely do all the planets align in the WC world.  This is one instance.  Check back in tomorrow.

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Filed Under: fee schedule, Virginia Tagged With: community, level of reimbursement, statewide, VWCC

No Fee Schedules Cost Employers WC $ – Virginia Update

November 12, 2014 By JL Risk Management Consultants

No Fee Schedules Cost Employers $$$

The lack of Fee Schedules cost employers dearly in extra workers compensation premiums. 

Dollar Cash Fee Schedules Cost Employers Picture

StockUnlimited

After looking at the chart again from yesterday’s article on WCRI’s 16 state report on medical costs, there is an obvious trend that is very apparent on Workers Compensation medical costs.

The chart points out an obvious fact that has appeared in this blog many times.  Fee schedules do save employers Workers Comp premiums or direct payout for self-insureds.

One can look at the chart for just a few seconds and the fact becomes apparent – states should enact fee schedules if one does not exist.

From the chart, four of the top five in hospital costs do not have fee schedules for hospitals.  There is nothing like a chart to point out something which is beyond obvious.

The states- Iowa, Indiana, Virginia, and Wisconsin have higher hospitalization and overall medical costs.  Employers in these states are sometimes in networks provided by their carrier or TPA.   PPO reductions by the medical networks may be the saving grace for employers in these states.

Update – In 2017, Virginia added a fee schedule to their Workers Compensation rules. 

Hand Drawing Fee Schedules Cost Employers Upward Arrow With Dollar

StockUnlimited

Hospitals and other medical providers in states that have enacted fee schedules are doing well in such states as Tennessee and Texas.

North Carolina is in a hybrid situation as the state did enact a fee schedule of sorts for hospitals.  The state also has had a fee schedule in place for many years.

One would expect the non-fee schedule states to at least attempt to legislate some type of fee schedule in the coming months.   However I said the same thing in 2007.

For more information  please click on the links to see previously written articles on fee schedules.  The lack of fee schedules cost employers every time they renew a WC policy.

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Filed Under: fee schedule Tagged With: higher hospitalization, very apparent

Workers Comp Fee Schedules – Follow Up To My Last Post

May 1, 2014 By JL Risk Management Consultants

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.

Picture Of Pill Capsules Workers Comp Fee Schedules On US Paper Currency

StockUnlimited

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.

Senior Doctor Workers Comp Fee Schedules Holding X Ray

StockUnlimited

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

  • NCCI Studies Physician Fee Schedules (2013)
  • Tennessee and Illinois Fee Schedules Working (2012)
  • WCRI Conference – Illinois Fee Schedule Trended Costs Downward (2014)

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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Filed Under: fee schedule Tagged With: physician bills, physician charges, prognosticator

Fee Schedules Effect on Workers Comp Costs – New Study From NCCI

April 30, 2014 By JL Risk Management Consultants

NCCI Study on Effect of Fee Schedules

NCCI is one of my favorite companies.  They recently produced a great study on  fee schedules.

Old picture of woman fee schedules using old telephone

Wikimedia Commons – Internet Archive Book Images

They have always been very nice to me and oh, so helpful at any of their meetings and conferences that I have attended over the years; and their phone assistance is great. Similar to WCIRB (California) and WCRI (independent research company), the  research produced by NCCI is always insightful and the best when it comes to Workers Comp medical costs. 

The newest study by NCCI can be found here.(PDF file)  I may be viewing the term “physician impact fees” incorrectly.   However, fee schedules have and always will reduce costs when compared to paying a Usual and Customary rate.  The key findings from the NCCI study were:

  • Large discounts off the WC physician fee schedule maximum allowable reimbursements do not ensure low prices 
  • WC MARs not only limit payments, they may also become common WC prices—the median WC price is always at or very near the fee schedule 
  • Surgery has higher fee schedules than Evaluation and Management relative to Group Health payments 
  • Similar WC discounts do not necessarily imply similar prices relative to Group Health: 
  • In some states, even after large discounts off the state physician fee schedule, the prices for some services may remain high relative to Group Health payments 
  • In other states, a smaller discount may produce prices more in line with Group Health payments

Instead of me opining on the study, please feel free to comment on the study or email me at [email protected] .   I will add more comments on the study this week or the next. 

 

©J&L Risk Management Inc Copyright Notice

Filed Under: fee schedule Tagged With: Customary rate, group health, maximum allowable rate, physician impact fees

WCRI- live – Illinois Fee Schedule Caused 30% Reduction in Medical Costs

March 12, 2014 By JL Risk Management Consultants

Illinois Fee Schedule Reduction Causes Changes

The Illinois fee schedule reduction of 30% – blogging –  WCRI live.

30% across the board reduction by Illinois and its effects

As with most across the board cuts in WC in other states over time, the costs per claim were not reduced in total by 30%.   I am not a fan of synthetic fee schedules.   A synthetic fee schedule is one that does not follow the usual fee schedule structure as is most other states. 

Major surgery fees were not reduced.  Illinois was the third-highest state in major surgical fees post-fee schedule reduction.

Graphic of 30 % Illinois Fee Schedule Reduction

(c) 123RF

Fees for office visits, physical medicine, and pain management injections were reduced the most (25%, 27%, and 26% respectively.)

Reasons for less than 30% reduction

  • Network penetration and resulting discounts
  • Negotiated prices were not to the 30% level
  • More complex office visits than before the reduction

I think Illinois had the right idea, but as I have presented in a few articles, a straight synthetic fee schedule is not the best approach.   However, kudos to Illinois for trending down overall costs regardless of not reducing costs by 30%.   It is a start that can be adapted in the future- possibly with some of the reduction elements in Texas or other states.

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Filed Under: fee schedule, Illinois Tagged With: office visit, physical medicine

Physician Fee Schedules NCCI Conducts 31 State Study

June 4, 2013 By JL Risk Management Consultants

Physician Fee Schedules Studied By NCCI

The National Council on Compensation Insurance (NCCI) recently published two studies on the effects of fee schedules on physician charges.   These were supposedly the first studies that analyzed this specific type of data.  However, the Workers Compensation Research Institute (WCRI) has performed similar studies.  The WCRI analyzes different data sets than NCCI.

The first study analyzed physician costs with the introduction of fee schedules for Tennessee and Illinois only. No other states were analyzed in the first study.

Clock and book Physician Fee Schedules illustration

Wikimedia Commons – Gentaur

The second study was an analysis of the physician charges for any fee schedule changes in 36 states. NCCI is the rating bureau for 36 states.  Those states are listed at the end of this article.  The NCCI assists in ratemaking for most of the aforementioned states along with other services.

Unfortunately, there are still five states reporting to NCCI that still do not have a fee schedule.  They are:

  • Iowa
  • Indiana
  • Missouri
  • New Hampshire
  • Virginia

The data for both studies is based on the information the carrier’s report on NCCI on employers in each of the 31 states.  The data is reported to the carrier for each insured employer in the 31 states on at least an annual basis.

First Study

There were predictions that Tennessee and Illinois would experience tremendous cost savings by instituting fee schedules.  The first NCCI study affirmed this conclusion.

According to NCCI:

  • Tennessee, the price level declines in excess of 7 percent, and the annual rate of inflation lessens by 0.3 percentage points.
  • Illinois, the price level drops by slightly more than 5 percent and the annual rate of inflation decreases by 0.6 percentage points.

These are significant savings without having to do more than enact a fee schedule.  The states without fee schedules for Workers Compensation should look at these numbers closely.

Second Study

The conclusions drawn from the second study were a little more vague than the first:

  • Utilization index by month was developed
  • Price inflation of medical services provided by physicians in the context of workers compensation tends to fall short of the rate of price inflation of the Medical Care component of the Consumer Price Index.
  • A lowering of price did not result in an over-utilization.
Picture of Physician Fee Schedules NCCI

StockUnlimited

The third bullet would be expected as physicians are not usually the medical providers that over-utilize their services when experiencing price cuts.   Services such as physical therapy have shown some tendencies for over utilization as a response to lowering rates for their services.

The study covered these states:
AK, AL, AR, AZ, CO, CT, DC, FL, GA, HI, IA, ID, IL, IN, KS, KY, MD, ME, MO, MS,
MT, NC, NE, NH, NM, NV, OK, OR, RI, SC, SD, TN, TX, UT, VA, and VT

©J&L Risk Management Inc Copyright Notice

Filed Under: fee schedule, NCCI Tagged With: data, First Study, Indiana, Second Study

Medical Fee Schedules Virginia Inaction Cost Employers 13%

February 28, 2013 By JL Risk Management Consultants

Medical Fee Schedules – Virginia Legislature Moves On To Other Things

Virginia’s decision on medical fee schedules will cost the state’s employers dearly.  The Virginia State Legislature decided to not act on fixing their Worker Comp medical fees.  As I pointed out in previous posts, Virginia is one of the few states without a true pure medical fee schedule.

Graphic of form pill up by man hand Medical Fee Schedules Health Insurance Claim Form

(c) 123rf.com

The state is one of the better ones for Workers Compensation rates.  However, there is still room for improvement.  As with all states that do not have fee schedules, the majority of the Workers Comp claims value is higher than states with fee schedules.

The % is surprising for Virginia – one of my favorite states.  According to the venerable NCCI,  64% of Virginia’s Workers Comp claims cost is due to medical treatment.

 In VA’s neighboring states, the % of medical vs. indemnity is 51% of claims costs.   That 13% extra has an element of very bad timing as employers are wrangling with the Obamacare mandates.


A great example of what happens when fee schedules are initiated is the state of Tennessee.  Their Workers Compensation costs dropped dramatically after a fee schedule was legislated into existence.

  

How does a state legislate in a fee schedule?  They can take a copy of North Carolina’s or Tennessee’s and it is a done deal.


Virginia has always been on the cutting edge in technology, colleges, wineries, and of course, has a large amount of influence from DC in the northern part of the state.  They dropped the ball on this one.


One of the reasons/excuses you will hear is that medical practitioners will not see Workers Comp patients.  To that, I say BULL.   

 

I have advised on Workers Comp policies in every state in the Union and have never seen this happen.  Workers Comp pays well for medical treatment.  

©J&L Risk Management Inc Copyright Notice

Filed Under: fee schedule, Virginia Tagged With: colleges, wineries, wrangling

Iowa Approves 7.9% Rate Increase In a Down Economy?

November 15, 2012 By JL Risk Management Consultants

Iowa Approves 7.9% Increase in Rates (Ouch)

The state of Iowa Approves a 7.9 percent rate increase.   NCCI recommended that Iowa increase its Workers Compensation rates by 7.9% (3% effective 01/01/13 + additional 4%  on 07/01/13).  Iowa subsequently approved the rate increases. This was rather surprising in such a down economy.  Iowa for many years bucked the trend that a medical fee schedule is needed to keep Workers Comp costs in check.

Graphic of Iowa Approves Gold percentage and increase arrow

123RF

The trend-bucking may be coming to an end very soon.  I have always said states that do not have a WC fee schedule end up costing employers more than other comparable states.  For some reason,  Iowa stood alone in not having a medical fee schedule while keeping medical costs in check.

The bell may be tolling for Workers Comp medical costs in Iowa.  Up until 6 months ago, Iowa was still defying the medical fee schedule = lower Workers Comp costs scenario.

The effect of no fee schedule seems to have taken hold in Iowa.  According to NCCI:

  • 58% of total benefits in Iowa are now medical.
  • The % of medical benefits is increasing faster than other states
  • Overall costs are quickly catching the regional and national averages
  • The change in medical benefits greatly exceeded changes in indemnity benefits
  • No other reasons such as medical inflation, etc were found as root causes of the increase

    Cheerful Woman Iowa Approves Showing Hand Gesture

    StockUnlimited

This is the normal time a state starts looking into a medical fee schedule.  Many states that have considered WC fee schedules usually wait until the situation is dire then switch to one.

Iowa should definitely consider having a medical fee schedule.  It is very easy to copy off another state and institute that fee schedule with follow-up adjustments.

The old warning concerning medical providers refusing to treat Workers Comp patients is very minor.  I have not seen that situation occur very often after a state enacts a Workers Comp medical fee schedule.

©J&L Risk Management Inc Copyright Notice

Filed Under: fee schedule, Iowa, NCCI Tagged With: defying, national averages, very minor, warning concerning

Indiana Rate Increase = Sharp Increase In Medical Costs

October 2, 2012 By JL Risk Management Consultants

Medical Cost – Indiana Rate Increase of 5%

The Indiana rate increase in medical cost should come as no surprise. Yesterday, I posted on the increase in Indiana’s advisory rates of 5%.  I had actually written the article under the impression that the lack of a fee schedule was to blame for the increase.

Graphic of Percentage and Red Arrow Indiana Rate Increase Medical Cost

(c) 123rf.com

I was right as NCCI has said the increase was due to a striking increase in medical costs in Indiana.  The adoption of a fee schedule would eventually turn the tide on the medical costs in the state.  As I have posted often, any Workers Comp changes will affect a state gradually over the next four years.  There are no quick overnight fixes in Workers Comp.

The changeover would not take that long nor be that complicated as they could use a good fee schedule such as Tennessee’s and just add in a factor due to different economies of scale in each state.

One of their neighboring states, Illinois, had installed a fee schedule a few years ago.  The last recommendation from NCCI that was accepted by Illinois was a  3.8% cut in rates.  Tennessee saw a 5% cut.

The reason for a smaller decrease in Illinois was the fee schedule has not had time to fully work itself into their WC system.  Additionally, IL used what I would call an artificial fee schedule at the very beginning of the switch.

There may be an excellent reason that Indiana does to want a fee schedule for Workers Comp such as a large medical lobby, or wanting to be totally independent.  Saving their employers WC $ is obviously not one of the goals.

©J&L Risk Management Inc Copyright Notice

Filed Under: fee schedule Tagged With: artificial fee, neighboring states

Work Comp Fee Schedules – Savings Do Not Stop There

August 30, 2012 By JL Risk Management Consultants

The Savings Do Not Stop With Work Comp Fee Schedules

The Work Comp Fee Schedules have always been a way to cut comp costs.  the savings do not stop there.NCCI had lowered the loss costs or advisory rates for Illinois and Tennessee. The reductions were due to both states enacting fee schedules a few years ago. This will save employers in both states millions in Workers Comp costs.

Graphic of work comp fee schedules no money symbol

(c) 123rf.com

As I said in my post yesterday, there are many other additional savings beyond just a fee schedule. Self insured employers will usually have their Workers Comp TPA also do their bill review. That is a good step as almost all TPA’s have a medical treatment network that will reduce the in-network medical bills by 15%.  

The TPA’s will likely offer pharmaceutical, physical therapy, radiological, and many other types of networks.

The same 15% reduction will also be available to non-self insured employers that are paying premiums for coverage with their carrier. The carrier will usually provide various networks similar to TPA’s.

The one big difference between TPA’s and carriers is that carriers will usually only provide one certain network for employers. Sometimes the TPA’s will have multiple networks from which to choose. The self-insured employers will sometimes request the TPA interface with the employer’s own choice of a network.

The 15% reduction is a big IF as the employer has to make sure the injured employees:

Emoticon of work comp fee schedules Sliding on Red Arrow Savings Do Not Stop

(c) 123rf.com

  • Treat in-network and not roll the dice and hope wherever the employee treats is in-network. We have seen in our file review for employers the 15% offered savings was not used as often as possible. Throwing away 15% on med costs can be costly over time, especially in the medical cost spiraling states such as California
  • See the most competent industrial minded medical providers are being chosen out of the network. If a $75,000 questionable medical procedure is performed, then the 15% saving will seem puny at best.
  • Treat with medical providers that are great communicators. As I have said often, communication is the largest cost saver in Workers Comp – no doubt about it. Return to work issues can often be resolved with an open dialogue between the employer, employee, and medical provider.
  • Rehab nurse recommendations – very often the rehab nurse assigned to the file knows the local players in the medical treatment networks better than anyone else. If the rehab nurse has an open dialogue with the nurses of the medical providers that are in-network, you are reaping huge savings.
Graphic Work Comp Fee Schedules Savings

StockUnlimited

There are many boutique medical providers that will help you as an employer set up the proper medical treatment “in-network” networks. Make sure you check out their backgrounds as we have found some very unscrupulous dealings in this type of network. Biggest is not always the best in this case.

 If you want to know of one in your area, email me.   Hopefully, more states will institute work comp fee schedules. 

©J&L Risk Management Inc Copyright Notice

Filed Under: fee schedule Tagged With: Lost Costs, pharmaceutical, radiological, spiraling

Workers Comp Medical Fee Schedules – Are They Worth It?

June 4, 2012 By JL Risk Management Consultants

Medical Fee Schedules For Workers Comp

Workers Comp medical fee schedules are they worth it for the state without one to act for their constituent employers?

Missouri, New Jersey, Wisconsin, Indiana, Iowa and Virginia all have two things in common that only these six states share.

Picture Of Medical Personnel Medical Fee Schedules Pouring Medicine From Bottle

StockUnlimited

I had written about the two things in common a few times in the past. The title does give it away.

They are the states that still do not have medical fee schedules for Workers Compensation treatment of injured employees. In 2009, I wrote this article on states without medical fee schedules. Missouri and Iowa were lower for medical costs then, but that has all changed very quickly.

I find that astounding after it has long been proven that any state without a medical fee schedule is harming businesses indirectly. The states without one were 27 – 51% higher in the cost of medical treatment. 

The main similarity is they are the most expensive states for Workers Comp medical treatment according to a recently released study on medical fee schedules. The Workers Comp Research Institute (WCRI) recently released a study titled Medical Price Index for Workers’ Compensation (MPI-WC). The WCRI studied 25 states.

Picture Medical Fee Schedules Personnel Showing Hand Gesture

StockUnlimited

Tennessee was the best case example for using a fee schedule. Workers Comp medical treatment in Tennessee was very expensive before they enacted a fee schedule along with other reforms. Tennessee’s medical care cost for Workers Comp is now in line with most fee schedule states. It used to be one of the highest in the nation.

Wisconsin has become the bellwether for states that do not have a fee schedule. Their medical index cost was almost 200% more than the median. Wisconsin employers are feeling the effect in their Workers Comp E-mods and premiums.

The bottom line answer to the question is that Workers Comp fee schedules are beyond critical for controlling Workers Comp costs for employers. The employers in the aforementioned state should be pushing their lawmakers to pass some type of medical fee schedule very soon.

©J&L Risk Management Inc Copyright Notice

Filed Under: fee schedule Tagged With: Bellwether, Iowa and Virginia, Missouri

Virginia Has High Medical Costs Per Claim According to WCRI

February 14, 2012 By JL Risk Management Consultants

High Medical Costs Per Claim In Virginia

A recent study by WCRI indicates that the state of Virginia has one of the higher medical costs per Workers Compensation lost time claim. WCRI’s recent study included 16 states. Virginia’s average medical cost per claim was 22% higher than the median state.

Graphic Of Silver And Golden Medicines And Money Medical Costs Per Concept

(c) 123rf.com

The reason for the high medical costs may be attributed to the fact that Virginia does not have a fee schedule. I am not inferring that any state without a fee schedule will have a high level of medical costs. In October 2009, I compared other states that did not have a fee schedules and found them to be much more expensive than states with fee schedules. Tennessee reduced its medical costs significantly by adding in a Workers Comp medical fee schedule.

I thought I would research Virginia’s medical costs even further. According to the NCCI in April 2011, Virginia’s medical costs were 23% higher than any of the states in the same region. The comparison by NCCI included Kentucky, Maryland, DC, and North Carolina.

I would have to agree with the WCRI’s overall conclusion -over time trends in medical prices are lower in states with fee schedules. I hope that Virginia will in the future follow Tennessee’s lead and enact a fee schedule. The results will be positive.

There is an old and unfounded rumor that any state that enacts a fee schedule will cause a reduction in the availability of medical care for Workers Compensation claims. I have never seen this occur in any of my research. 

Most Workers Compensation medical payments are higher than the comparable group health figures.   One of the main complaints that have now faded was workers compensation carriers and Third Party Administrators tend to pay slower than other lines of insurance. 

©J&L Risk Management Inc Copyright Notice

Filed Under: fee schedule Tagged With: comparable group, lead and enact

Is Virginia Most Expensive State For WC Medical Costs?

December 2, 2011 By JL Risk Management Consultants

Virginia The Most Expensive State

The most expensive state for WC medical costs is Virginia. This article is a follow-up from this post on medical costs. The previous article examined Workers Comp medical costs in Virginia as being the highest in the nation. I decided to see if NCCI agreed with the Workers Comp Research Institute (WCRI). The NCCI and WCRI are both great data sources for Workers Compensation.

Map of Virginia Most Expensive State for WC Medical Cost

(c) 123rf.com

I compared each of the states in Virginia’s general area to see if the medical costs were actually that high. I was shocked to find that Virginia had such high medical cost severity.

  • VA – $44,000
  • DC – $18,000
  • KY – $34,000
  • MD – $28,000
  • NC – $32,000

Operating without a fee schedule usually means the employers for that state will pay more in medical costs – plain and simple. It would be very wise for Virginia to enact some type of Workers Comp fee schedule. There are neighboring states with great fee schedules they could adopt very quickly.

Will this situation improve in the future? I actually doubt it. As long as medical fees are allowed to be charged with no checks and balances in place, employers in states such as VA will be near the top in Workers Comp medical costs.

©J&L Risk Management Inc Copyright Notice

Filed Under: fee schedule Tagged With: charged, Severity, top in

Where Do I Find Workers Compensation State Medical Fee Schedule?

January 18, 2011 By JL Risk Management Consultants

A State Medical Fee Schedule Usually Saves Funds

States without  a Workers Compensation medical fee schedule become more rare every year.

Picture of Doctor Writing Fee Schedule of Patient

StockUnlimited

At last count, there are approximately 42 states with fee schedules.  They basically allow a maximum charge for a medical provider (physician, hospital, physical therapist, etc.) per CPT code.  The CPT codes became much more complicated with the ICD 10 code arrival. 

The medical provider can charge much more than the fee schedule. The charge will be cut to the schedule unless there are extenuating circumstances.

In some states, a BR or by report is added to the CPT code to let the insurance carrier and the Industrial Commission know that their bill needs to be reviewed individually and not just cut to fee schedule. I often see BR CPT codes coming from university-based medical providers such as Duke University Medical Systems.  

The BR does not denote a medical provider overcharging for their services.   The medical provider feels the fee schedule amount of the CPT codes does not represent the fees charged if the carrier/TPA uses the standard schedule.

Update – the ICD10 codes have been released in 2013.  These codes may end up changing some of the workers comp procedure codes in the very near future. 

©J&L Risk Management Inc Copyright Notice

Filed Under: fee schedule Tagged With: CPT codes, Medical Providers

Workers Comp Medical bill fee schedule Nonexistent In Few States

January 5, 2010 By JL Risk Management Consultants

Corrected on States Without Workers Comp Medical Bill Fee Schedules

The States of Virginia Workers Comp Medical Bill Fee Schedules does not exist.  A few weeks ago, I posted a blog on the States that have no medical fee schedules. I stand corrected as I left Virginia out as a state without a fee schedule. The states without a medical fee schedule are Delaware, Indiana, Iowa, Missouri, New Hampshire, New Jersey, Virginia, and Wisconsin. This comes from an advisory memo from the CMS (Centers for Medicare and Medicaid Services)on errors made when submitting Workers Compensation Medicare Set-aside Agreements (WCMSA or MSA – more on that in a later post).

Picture of Workers Compensation Medical Bill Fee Paper and Stethoscope

123RF

I do not go back and redo corrections in the original posts. My prior blog post left out Delaware and Virginia as not having fee schedules. Virginia is one of a kind state on their Workers Comp medical fee schedules. Medical providers in Virginia bill using rates based on medical charges that prevail in the same community for similar treatment. That would make Virginia a non-fee schedule state.

However, Delaware does have a fee schedule. I am looking at it as I type this post. I will research and see why the Federal Government thinks that Delaware does not have a fee schedule.

I will post the next time on MSA’s which employers that have serious claims should be very familiar with overall. If you are reading this and you have not heard of MSA’s, please check out my next post. Employers can be hung out to dry on this part of a claim.

©J&L Risk Management Inc Copyright Notice

Filed Under: fee schedule Tagged With: New Hampshire, Workers Comp community

Workers Compensation Medical Fee Schedules – Not In These States

October 15, 2009 By JL Risk Management Consultants

Workers Compensation Medical Fee Schedules

Workers Compensation medical fee schedules do cut comp costs.

Picture of stethoscope dollars and pills Workers Compensation Medical Fee Schedules Cost

(c) 123rf.com

After my last post, I received the question – Which states still do not have a fee schedule for their Workers Comp medical bills? After some research, I found out that there were now only five states left without a fee schedule. I did not delve into why they do not have one. I wanted to see if their medical bills were higher such as in the case of Tennessee before they enacted their modified fee schedule.

The five are:

  • Iowa – was actually lower than the neighboring states with fee schedules
  • Indiana – medical payouts were 33% higher than the median value.
  • Missouri – were actually lower than the neighboring states with fee schedules
  • New Hampshire – 73% of claim payouts were for medical, while neighboring states with fee schedules were at 49%.
  • New Jersey – data is very hard to find on NJ as they have their own rating bureau.
  • *Tennessee – even though they now have a fee schedule, their prior medical payouts were 36% higher than the median value.

This led me to research into whether these states have higher Workers Comp medical bill costs. What I found was that the states without a fee schedule were much more expensive than states with a fee schedule. Iowa and Missouri have both proved my theory as not completely accurate.

I could research the medical costs further, but for now I will just say that any state with runaway medical costs such as NH and IN should immediately enact fee schedules. As IA and MO have their medical costs under control, no fee schedule may be needed.  

2020 Update – Iowa and Missouri became expensive states.  Either state does not have a worker’s compensation medical fee schedule as of this year. 

©J&L Risk Management Inc Copyright Notice

Filed Under: fee schedule Tagged With: median value, New Hampshire

Tennessee Workers Comp Health Costs Controlled By Fee Schedule

October 13, 2009 By JL Risk Management Consultants

Tennessee Workers Comp Health Costs Lowered 

Fee schedules for Tennessee Workers Comp health Costs work reduced medical costs in the state without question. Most of the Workers Compensation data has shown that medical costs have been outpacing all other costs in Workers Comp claims. Medical costs are now approaching 60% of the total claim value in many states.

Vector Graphic Of Dollars Workers Comp Health Costs And Stethoscope

StockUnlimited

Many state governments have actually reduced Workers Comp medical costs by becoming more involved in the claim process. This is one instance of a program that is partially administered by state governments. I am referring to fee schedules.

Fee schedules are one of the most efficient and effective methods to reducing Workers Compensation costs. All states that have enacted fee schedules in the recent past have experienced a reduction in the medical costs per Workers Compensation claim.

I have yet to see any medical provider turn away patients as the result of a fee schedule being enacted.  Workers Compensation pays medical providers quite healthy fees for their services.  

I had recently read an article in the National Underwriter that the state of Tennessee had lowered their Workers Comp medical costs significantly by $1,300 per claim. Stop and think for one moment. What individual medical charges would have been reduced the most by a Workers Comp fee schedule in Tennessee?

The major fee reductions per types of services were as follows:

Outpatient

   Minor radiology – 15%

   Physical medicine – 12%

Inpatient

   Minor radiology – 43%

   Major radiology – 34%

   Physical Medicine – 23%

These are very stark numbers. The state of Tennessee is to be congratulated on their efforts to help cut workers comp costs. Their medical costs are now more in line with the rest of the states with fee schedules.

There are definitely ways that a state government can aid employers in reducing Workers Comp costs. This is a prime example.

©J&L Risk Management Inc Copyright Notice

Filed Under: fee schedule Tagged With: inpatient, major radiology, National Underwriter

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James J Moore
Raleigh, NC, United States

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:
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