Thursday, February 27, 2014

NEW FEE SCHEDULE UNLIKELY TO IMPROVE ACCESS



WCRI (WORKERS COMP RESEARCH INSTITUTE) SAYS THE NEW FEE SCHEDULE COULD IMPROVE ACCESS: Nonsense!


The WCRI said that the new fee schedule could change utilization patterns because it would increase pay to primary care providers. In the same breath WCRI admitted that "the institute does not expect that to be the case in California." The workcompcentral story by Greg Jones, 2014-02-21, stated that "a 2012 WCRI study  concluded that prices paid for office visits in California were 30% below the median of the 25 states that were reviewed, with only North Carolina and New York paying less."


By eliminating independent payment for reports under 99080 and by eliminating independent payment for review of boxes and crates of medical records under 99358, harm has been done that cannot be repaired by raising an office fee by $8. THAT is what was done in 2007 in California when office visits for CPT 99213 were raised from $45 to $53. The new codes under the RBRVS make similar smidgens of adjustment. THAT may be enough to fool WCRI, but it won't fool even the most junior accountant or office manager in any medical or surgical office.


The workcompcentral story by Greg Jones said that "there are some who think that California's payment rules prohibiting payment for record review ... will impede the ability of injured workers to receive treatment." It is then noted that "Medicare doesn't reimburse record review." That's because "The Centers for Medicare and Medicaid Services considers the cost of reviewing records to be bundled with the office visit payment." What utter and complete nonsense! Now that that miserly process has been shoved into Workers Comp, it is still somehow expected that after an hour or so with a patient another few or several hours will be devoted gratis to review of records. The treating doctor will be obliged to spend less time with the patient to allow time for review of records. In most cases, that adjustment will not suffice.


References


"New Fee Schedule Could Improve Access, WCRI Says," workcompcentral.com, 2014-02-21.


"CWCI and WCIRB: SB 863 lowered surgical center payments in California," Insurance Journal, 2014-02-26  (this article points out that facility fees were brought down by 26% and that procedure fees were brought down by 28%. An argument for the WCRI position is that if these centers are still in business despite across-the-board fee reductions then the fee reductions are viable despite the squawks of providers)







1 comment:

  1. cheap rolex watches, combining elegant style and cutting-edge technology, a variety of styles of cheap rolex milgauss watches, the pointer walks between your exclusive taste style.

    ReplyDelete