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Fee Schedules are a Good Thing

An InsuranceJournal article reports on a new Workers’ Compensation Research Institute study indicating that states with set fee schedules tend to have lower hospital outpatient costs than states that have not adopted a fee schedule.  

The study included one interesting comparison between the Sunshine State and the Golden State. California and Florida both enacted fee schedules at the same time, but Florida’s fee schedule was based on a percentage of the charges, rather than California’s “ambulatory payment classification”. As a result, California controlled the growth of medical costs with more success than its Eastern counterpart.

Lien claimants will regularly bill more for services than they should.  They know the rules and the maximum reimbursement, but they do this anyway hoping to pressure a settlement.  Don’t let them get away with it!

Here is a list of links to various California Code of Regulations sections discussing the fee schedule as it applies to various categories (durable equipment, inpatient hospital services, etc.)  Make sure that the lien claimants are not overcharging for their so-called “services.”  If when they do, either through bill review or just applying the appropriate fee schedule, set the beginning point of negotiations at the adjusted amount for their charges.

And, apparently, go California!

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