Medical payments in the state – the largest for workers compensation insurance – dipped 5 percent in 2013 for claims with more than 7 days of loss and 12 months of experience, the Workers Compensation Research Institute found in a new study.
By contrast, the study found that medical payments per claim grew in 2013 in many of the 17 states WCRI included in its study, “CompScope Medical Benchmarks for California, 16th Edition.”
The WCRI said that the dip is likely connected to 2012 workers compensation reform legislation. From 2010 to 2012, medical payments per workers compensation medical payments per claim saw moderate growth, the WCRI said.
Here’s why WRCI makes the link: Sections of the reform law reduced fee schedule rates for services at ambulatory surgical centers. It also ended separate reimbursement for implantable medical devices, hardware, and instruments for spinal surgeries. Additionally, the reform law requires a $150 fee to file liens against an employee’s workers compensation benefits and a $100 activation fee for liens already filed.
Other findings: Ambulatory surgical center payments per claim dropped nearly 24 percent in 2013.
It is unclear how a new phase of the workers compensation reform law will affect rates. According to WCRI, the law began phasing in the use of a fee schedule in January, 2014 based on Medicare’s resource-based relative value scale (RBRVS).
The transition will take place over four years and stay in place until the Division of Workers Compensation adopts a RBRVS fee schedule that allow for a maximum of 120 percent of the aggregate fees allowed by Medicare. The WCRI said that the change led to higher prices paid for primary care in 2014, though some specialty prices decreased.