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Medical payments per comp claim down in North Carolina

Medical payments per comp claim down in North Carolina

Medical payments per workers compensation claim in North Carolina decreased 6% per year from 2013 through 2015, according to a study released Thursday by the Cambridge, Massachusetts-based Workers Compensation Research Institute.

The decreases in medical payments per claim are likely due to fee schedule rules, which base reimbursement for nonhospital and hospital care on Medicare methodology that took effect in 2015, according to the WCRI.

Since 2012, payments for hospital care became a smaller share of North Carolina’s total medical payments per claim, with a decrease from 53% in that year to 48% in 2013-2014 and 42% in 2015-2016. The share of payments for hospital outpatient care decreased from 32% in 2012-2013 to 29% in 2014-2015 and 24% in 2015-2016, according to the study.

“Policy changes in recent years have targeted a key cost driver of workers compensation claims in North Carolina — hospital costs. New fee schedule rules became effective in 2015, with reimbursement based on a percentage of Medicare. The medical data we report provide an early look at the effects of those changes,” Ramona Tanabe, executive vice president and counsel at WCRI, said Thursday in a statement.

The study examined medical payments, prices and utilization in North Carolina and compares them with 17 other states, the WCRI said.



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