Medical Fees: Does One Price Fit All?


The Federal government has proposed a simplified medical billing process that may impact workers' compensation billing practices going forward. Most workers' compensation fee medical fee schedules are linked either directly and indirectly the to Federal Medicare model and a proposed Rule published last week in the Federal Register proposes a single fee for all office visits.

Valuing medical services at one rate in workers' compensation would eliminate litigating medical fee disputes and would also establish a more uniform fee payment system and certainty for insurance companies to anticipate medical costs.

The following is shared from the NY Times:

"The Trump administration is proposing huge changes in the way Medicare pays doctors for the most common of all medical services, the office visit, offering physicians basically the same amount, regardless of a patient’s condition or the complexity of the services provided.

"Administration officials said the proposal would radically reduce paperwork burdens, freeing doctors to spend more time with patients. The government would pay one rate for new patients and another, lower rate for visits with established patients.

"'Time spent on paperwork is time away from patients,' said Seema Verma, the administrator of the Centers for Medicare and Medicaid Services. She estimated that the change would save 51 hours of clinic time per doctor per year.

Click here to read the entire article.

Click here to read the Proposed Rule in the Federal Register.

Click here to read the CMS press release.

Click here to read the CMS Fact Sheet.


 Jon L. Gelman is nationally recognized as an author, lecturer and skilled trial attorney in the field of workers’ compensation law and occupational/environmental disease litigation. Over a career spanning more than four decades, he has been involved in complex litigation involving thousands of clients challenging the mega-industries of asbestos, tobacco, lead paint and burn pits. He is the author of the 3-volume treatise entitled Workers’ Compensation Law (West-Thomson-Reuters) and co-author of the national treatise of Modern Workers' Compensation Law (West-Thomson-Reuters).


Read More

Request a Demo

To request a free demo of one of our products, please fill in this form. Our sales team will get back to you shortly.