Our Positions | Fee Schedules


Fee schedules have been around for quite a while in workers’ compensation systems. Some states began as monopolistic entities who underwrote the compensation while the majority of states have been open markets for workers’ compensation insurance basically from their inception. Both models have had to be mindful of costs inherent in reimbursement of medical costs especially with continual and present medical inflation. The federal government through many of its social programs have instituted fee schedules which most states base their reimbursement rates. Generally, a fee schedule has a maximum reimbursable amount and any amounts over that figure are disallowed. States have implemented fees schedules that are based on a percentage of Medicare reimbursement. Other states have devised their own methods and beliefs as to what is a fair and reasonable reimbursement for medical claims including workers’ compensation. Fee schedules additionally:

  • Incentivize usage of cost effective treatments for claimants;
  • Deter over usage of costly proceedings that are not necessary for patient recovery;
  • Allow markets to reimburse at reasonable and necessary costs;
  • Foster injury/illness management in the most effective care plan;
  • Create stability in medical cost rating components; and
  • Encourage private contractual reimbursement arrangements fostering additional stability in the marketplace.

NAMIC POSITION

NAMIC supports the use of fee schedules to control medical costs which inherently rise each year due to medical inflation trends. Controlling costs in a workers’ compensation system is paramount to its longevity and vitality.

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Article Posted: 05.14.18
Last Updated: 05.14.18

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Sarah Schnettler
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  Sarah