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Workers comp doctors collect much less under new California fee schedule

Workers comp doctors collect much less under new California fee schedule

Physicians providing consultations to injured workers under California's workers compensation system saw a 31% decrease in payments in the first quarter of 2014 compared with the same period in 2013 due to changes in the state's workers comp fee schedule for physician services, the California Workers' Compensation Institute says.

The average amount paid to doctors for a visit with an injured worker involving a consultation was $62.46 in the first quarter of 2014, according to a report released by Oakland, California-based CWCI on Tuesday. That's down from $94.08 for visits involving a consultation in the first quarter of 2013.

CWCI noted that the price decrease is connected with changes under S.B. 863, a California workers comp reform bill that passed in 2012 and created or modified fee schedules for various workers comp-related services.

The overall average amount paid per physician report for evaluation and management services was $16.53 in the first quarter of 2014, down 36.7% from $26.13 in the first three months of 2013.

CWCI said physician fees seem to be declining because the state has shifted to using a “resource-based relative value scale” fee schedule in the first quarter of 2014, which changed ways in which physicians are able to report and bill for services. For instance, doctors can bill for an initial visit, but reports associated with an initial visit cannot be billed separately without approval from state workers comp officials.

The “initial results on physician reporting following adoption of the new schedule indicate that the change in the mix of reports has been the key factor in reducing the average amount paid for physician reports,” the report reads.

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