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Fee Schedule

Most states have medical fee schedules that list the reimbursement amounts per ICD 10 codes. State governments have reduced the cost of workers’ compensation medical benefits by enacting these workers’ comp medical fee reductions.

I have long been a proponent of workers’ comp fee schedules.  The organizations that track their effectiveness include the Workers’ Compensation Research Institute (WCRI) and the two major rating bureaus – National Council on Compensation Insurance (NCCI)  and California’s Workers Compensation Insurance Rating Bureau (WCIRB).

WCRI publishes key indices and studies on the effects of the fee schedules.  I have tracked one test state (Virginia) over the last few years to see if the Dominion State’s medical charges were reduced after the state decided to control the medical costs.

Virginia’s medical costs have been reduced greatly over the last few years.  Many other states such as Tennessee have seen their Workers’ Comp medical costs decrease over time.

A few states such as Iowa have decided to not enact any type of schedule for medical cost reduction.  This leaves the insurance carriers to usually pay higher rates which are passed onto the insured employers through higher premiums.

The WC insurance carriers are left to negotiate usual and customary fees for a medical provider in a certain area – known as U&C fees.

Adjusters struggle to set the proper reserve levels without having a guide as to how much the medical bills will cost without a schedule of some type.

Medicare/Medicaid fee structures are often used by states to set the reimbursed rates to providers.



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