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By Andrew Babitz

Senator Dave Schatz (R) of Sullivan, Missouri introduced a bill which would completely change how providers are compensated for treatment following work related injuries.  Presently, medical providers in Missouri are reimbursed on a usual and customary basis.  If a medical provider is usually and customarily paid $18,000 for a shoulder surgery, it should, in theory, be paid $18,000.00 for such a procedure.  A fee schedule would set specific prices for specific CPT codes based upon the type of facility and the nature of the treatment.

Other states, including Illinois and Oklahoma, have used a fee schedule for worker’s compensation claims.  As our office represents providers in these states, we can say with relative certainty that reimbursements for similar procedures are significantly less in fee schedule states than in Missouri.  The fee schedule takes arbitrary information and uniformly applies it to all providers regardless of a provider’s cost, skill and or retention rate.

As medical providers across the state of Missouri are having a difficult time meeting their own financial obligations, we strongly believe that a worker’s compensation fee schedule will create more financial stress and hardship for already cash-strapped providers.

The insurance industry will be lobbying hard to pass the legislation in this session.  The benefits for the insurance industry are easy to spell out.  If this legislation passes, the workers’ compensation carriers will be able to fix costs more easily, and correspondingly reduce their reimbursement on Missouri claims.

Our office has had informal discussions with representatives from the Missouri Hospital Association.  It is likely that the MHA will come out against this legislation because of the financial hardship it will place upon medical providers.  Our office urges all of our clients to discuss the matter with your respective elected officials.

If you have any questions or concerns, please don’t hesitate to contact our office at any time.

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