Medical payments per workers’ compensation claim stagnates in NC

There was little to no change in medical payments per workers’ compensation claim in North Carolina after 2009, an 18-state study conducted by the Workers Compensation Research Institute showed. The stagnation followed growth that averaged 6% to 7% per year from 2004 to 2009 at all claim maturities.

WCRI’s Executive Vice President Ramona Tanabe said the decrease is reflective of the 2013 interim changes in the state’s fee schedules. She noted “Hospital costs had been a key driver of medical payments per claim in North Carolina and prices paid to nonhospital providers were lower than typical. Administrative and legislative changes since 2013 addressed those issues.”

House Bill 92, which passed in 2013, mandated that reimbursement for all workers’ compensation medical care should have its basis in Medicare methodology. Proposed fee schedule rules were announced in November 2014 and were passed in February 2015. Phase-by-phase decreases for hospitals and ambulatory surgery centers were implemented in April 2015, and changes in reimbursement for professional services took effect in July 2015.

Contact our attorneys at Scudder & Hedrick, PLLC when you need someone to provide legal services in Raleigh or another area of North Carolina. Call us at (919) 851-3311 if you need help with filing for a workers’ compensation benefit claim today.