Workers Compensation insurance las vegas Fee Schedules

By: Stephanie Goldberg (Business Insurance) April 2014

Workers compensation physician fee schedules can help control costs, but a higher maximum reimbursable amount might lead providers to charge more for workers comp services than patients covered by group health plans, according to a report released Tuesday.

The National Council on Compensation Insurance Inc. report, “The Price Impact of Physician Fee Schedules,” analyzed medical services provided in 2011 in 35 states with fee schedules to compare workers comp with group health and Medicare costs.

The analysis concludes that discounts from fee schedule amounts don’t guarantee competitive prices in the health care marketplace.

Boca Raton, Fla.-based NCCI found that workers comp medical payments are higher than group health payments for comparable services — evaluation and management, surgery, radiology and medicine — with fee schedules, in some cases, setting the prices medical providers charge for workers comp services.

The study found that despite large discounts from the fee schedule, prices for services in some states remained high relative to group health payments, while smaller discounts in other states produced prices that were more similar to group health payments.

Maximum reimbursable amounts, which are specified by each state and generally are higher than group health rates, might lead providers to charge more for treating comp claimants, according to the analysis.

More than half of evaluation and management, surgery, radiology and medicine services for workers comp are paid below the maximum reimbursable amounts specified by each fee schedule, according to the study.

For group health, about two-thirds of payments for evaluation and management, 85% of payments for radiology and 80% of payments for medicine are paid below the maximum reimbursable amounts. Meanwhile, 25% of group health payments for surgical services are paid at amounts less than 40% of the maximum reimbursable amount.

The report is available here.

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