Effective May 2014, the outpatient reimbursement method in Georgia changed from an International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) based fee schedule to a Medicare Prospective Payment System (OPPS) based fee schedule. The same reimbursement method is applied for services delivered in both hospital outpatient settings and ambulatory surgery centers. The data in this report reflect up to 23 months of experience after this fee schedule change and help policymakers and stakeholders in the Georgia workers’ compensation system monitor the impact of this regulation change.
This study examines medical payments, prices, and utilization in Georgia compared with 17 other states (Arkansas, California, Florida, Illinois, Indiana, Iowa, Kentucky, Louisiana, Massachusetts, Michigan, Minnesota, New Jersey, North Carolina, Pennsylvania, Texas, Virginia, and Wisconsin). How these metrics of medical payments and care have changed primarily from 2010 to 2015 was also examined, though in some cases, we used a longer time frame to provide historical context for key metrics. Claims with experience through 2016 for injuries up to and including 2015 were analyzed.
The report can help policymakers and other stakeholders identify changes over time in the provision of workers’ compensation medical care; detect areas where medical payments per claim, prices, or utilization may be higher or lower compared with other study states; and reveal areas where legislative changes or system features and processes may be impacting the costs or delivery of medical services.
CompScope™ Medical Benchmarks for Georgia, 18th Edition. William Monnin-Browder and Rui Yang. October 2017. WC-17-36.
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