Compensation medical and legal costs in California skyrocket after changes

According to a CWCI study, payments for medical-legal services used to resolve medical disputes over compensation issues in California workers’ compensation claims increased “sharply” under the new Medical Fee Schedule. laws which came into force in 2021.

In April 2021, anticipating a 25% increase in costs, the California Division of Workers’ Compensation implemented a new fee schedule for the first time since 2006. The previous schedule provided lump sum payments for “basic” comprehensive assessments ” and “complex”. – payments based on valuations involving “extraordinary circumstances”.

The new schedule, which CWCI researchers say drove costs beyond forecast, replaced those three service levels with a single flat rate of $2,025 for medical examiners, plus $3 per page for reviews over 200 pages and time-based payments for video. Comments. The new scale also continued to allow additional fees for assessments by those involving an interpreter and fee multipliers expanded to certain medical specialists.

By comparing the utilization and reimbursement of medical-legal services rendered before and after the effective date of the new schedule, using claims data from accident years 2015 through 2021, the CWCI found that replacement of the three levels of assessment by a single full assessment reimbursed at a flat rate “probably had the greatest impact on average payouts.”

Basic assessments accounted for about 40% of paid assessments under the new full service code, and the new package increased payment for those services by 222%. More complex assessments accounted for 18% of new assessments and payments for these services increased by 115%.

While regulators hoped the new schedule would lead to a redistribution of forensic services, with fewer additional reports, reporting fell from 34.2% of forensic services in 2019 to 37.8% under the new schedule .

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