Providers are getting more “creative” than ever these days, with some - especially in California - taking advantage of loopholes in fee schedules to bill outrageous amounts for “services” with questionable impact on injured workers’ recovery.
Highly encourage my workers’ comp readers sign up for WCRI’s September 3 webinar addressing “Trends in Non-Price-Controlled Services.”
link is here.
A few details…
Of particular interest is the growing prevalence of unlisted codes in physical medicine (PM). Last year saw a huge jump in PM services coded as 97799 - “unlisted physical medicine”.
Note that jump happened while the use of normal/traditional/common PM codes for services including therapeutic exercises and manual therapy declined.
Oh, and these 97799 codes account for a third of all PM spend in California - at an average cost of $1700 each.
Unfortunately this epidemic has spread to NorCal and there’s some indication it may be crossing state lines - watch out Nevadans and Arizonans!
What does this mean for you?
WCRI’s research gives you actionable information. Is your payer doing something about this?