Intended Consequences

Earlier this year, April 1st to be exact, the Division of Workers’ Compensation (DWC) adopted changes to the Medical-Legal Fee Schedule (MLFS). This is the schedule governing the payment of … Read More »

Alternative MPN Bill Downgraded

Proposed legislation that threatened to undermine the curated medical provider networks that employers and insurance carriers use to keep medical costs down and fight fraud in the workers’ comp system is being downgraded. Assemblymen Eloise Gomez Reyes (D-San Bernardino) and Lorena Gonzalez (D-San Diego) are dropping plans – for now – to create a statewide … Read More »

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Researchers Recommend Status Quo For Surgery Center Fee Schedule

Researchers are recommending against creating a new workers’ comp fee schedule that would establish maximum payments to ambulatory surgery centers (ASCs) for procedures that Medicare considers to be inpatient only type surgeries. The findings by the RAND researchers to maintain the status quo likely means that payments will continue being negotiated on a case-by-case basis, … Read More »

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Opinions Differ On The Cost Impact Of The RBRVS Switch

California’s move to a Medicare-based payment system for workers’ comp providers is expected to increase costs for the state’s employers, but the amount of that increase is under debate. Some even question whether there will be any increase attributable to the new resource-based relative value scale (RBRVS) fee schedule itself and say inflationary adjustments alone … Read More »

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Seeking Consensus on Spinal Hardware Bill

Despite passing the Assembly Insurance Committee on a 12-0 vote, a bill that would eliminate the extra reimbursement in workers’ comp for spinal hardware, otherwise known as a pass-through, is getting an extra look by the author in hopes of reaching a consensus with all the stakeholders. Employer and labor support is strong and there … Read More »

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An End to Double-Dipping or Just Passing Through?

Hoping to weed out another source of abuse and possible fraud in California’s workers’ comp system, a bill working its way through the Legislature would eliminate the extra reimbursement providers receive for implantable medical devices for spinal surgeries. The cost of a device can add on average at least $15,000 to each spinal procedure, studies … Read More »

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