Workers Comp Cost-Containment Method in Jeopardy

By Staff Report

Jan. 21, 2010

The proportion of workers’ compensation medical costs subject to physician fee schedules is declining, threatening the effectiveness of the traditional cost containment measure, a report says.

Several factors are contributing to the trend, including medical providers shifting from charging private practice fees to billing for procedures through hospitals or other facilities that employ them, Boca Raton, Florida-based NCCI Holdings Inc. said in the report released Tuesday, January 19.

Billing by hospitals and the other facilities may not fall under a workers’ comp fee schedule, the rating and research entity said.

The report, “Medicare and Workers’ Compensation Medical Cost Containment,” examined how Medicare reimbursement rates influence prices paid for medical services, including those funded through state workers comp systems.
“To maintain the effectiveness of medical fee schedules, workers’ compensation [systems] might consider using Medicare billing approaches for hospital stays and ambulatory services, but in doing so should adapt Medicare models to workers’ compensation priorities,” NCCI said in the report.

The NCCI report is available online at

Filed by Roberto Ceniceros of Business Insurance, a sister publication of Workforce Management. To comment, e-mail

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