Fee Schedule, Schmee Schedule

In a meeting yesterday with a prominent and successful medical management company owner who processes and collects his customer's workers' compensation treatment bills, he admitted that he ALWAYS bills out procedures at 40 to 100 percent of fee schedule.

The reason is because regardless of what is billed out, insurance carriers routinely seek a discount in the payment/settlement of the bill, even if the bill is at fee schedule.

In order for his customers to make a profit then, the medical management company must over bill in order to collect at least the regulatory amount. And through clever tactics involving bundling of bills often times some amount in excess of fee schedule can be collected.

Add to this that it may take years to collect that receivable and the issue of cash flow plays prominently in the overall gaming of the system - by both carrier and provider.

The absurdity of this game is pervasive in workers' compensation, regardless of whether it is California, Texas, Florida, New York, Illinois ... Alaska.

So I'm trying to understand the utility of a fee schedule when it seems to be so universally ignored?

I had opined in an earlier post that a proposal to create a copy service fee schedule would benefit both payers and the copy services, but now I'm starting to wonder whether that is in fact a correct analysis.

Will a schedule just end up being ignored like it is with medical billing, and the problem of unpaid bills clogging the system with lien controversies just going to return, except with an even greater degree of technicality due to some "schedule"?

And while we're at it, how about educating the people that are responsible for outputting medical bills and collecting them - I'm talking about the line workers who are actually responsible for generating the paperwork?

As an example, our customer service representatives routinely take calls from clerical staff at medical collection agencies seeking to use the California EAMS system through the DWC Direct filing system. These line workers display a complete ignorance of the legal requirements in filing certain documents, such as liens or Declarations of Readiness (DOR).

In fact in a call just the other day the customer told our representative that they don't serve DORs on anyone, they just file them - that is how they were instructed to process this paperwork!

The customer was completely ignorant of Regulation section 10250 that mandates that DORs are to be served on all parties and lien claimants on a case!

Or the customer who told our representative that she was instructed to file a lien at the moment a billing goes out to the carrier - again completely ignorant of the requirement that there is a waiting period and completely ignorant of the fact that she is lying, under penalty of perjury, on the face of the lien claim form that she complied with Regulation 10770.5 time periods.

We take calls like this on a daily basis.

Everyone tries to save a penny in this system but expends a buck doing so....
workers compensation, work comp, injured worker