Workers’ Comp Study Reveals Positive Trend for Physician Fees

A new study verifies that the interim changes to North Carolina’s physician fee schedule for workers’ compensation claims in 2013 have had a positive impact on payment. With the more comprehensive updates to the fee schedule that took effect last July, it’s likely the payment trends for treating injured workers will continue to be positive.

The Workers Compensation Research Institute’s study, CompScope™ Medical Benchmarks for North Carolina, 16th Edition, examines medical payments, prices and utilization in North Carolina from 2008 through 2014, and compares them with 16 other states. The information is aimed at helping policymakers and other stakeholders involved in the North Carolina workers’ compensation system identify current cost drivers and emerging trends in payments, prices and utilization of medical services among nonhospital and hospital providers. Read the study, which will only be available free of charge until next Thursday, Oct. 29, 2015.

The data revealed that the interim fee change for evaluation and management (office visits) and physical medicine, which took effect in 2013, had a dramatic impact on reimbursement for treating workers’ comp patients.

In July of this year, a more comprehensive change to the North Carolina physician fee schedule took effect as the result of lengthy and intense negotiations with multiple medical specialties as well as the business community and other stakeholders. The North Carolina Medical Society (NCMS) through its Workers’ Comp Task Force and the efforts of NCMS Associate General Counsel Conor Brockett were instrumental in bringing about these positive changes. Watch a video about this process.

Until this change, North Carolina’s workers’ comp physician fee schedule had not been updated in 20 years, placing us near the bottom nationally among states with such fee schedules. This study confirms that North Carolina is moving up the ranks when it comes to physician reimbursement for treating workers’ comp patients.

“The report is useful for identifying where medical costs and care patterns may be changing,” said Ramona Tanabe, executive vice president and counsel for WCRI. “It also helps identify where medical payments per claim or utilization may differ from other states. In addition, where there may be concerns about restrictions on access to care, the study can help identify potential underutilization of medical services.”


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