MWHCA ADVOCACY Maryland Medical Fee Guide Revision Committee
Any health care provider who deals with worker's compensation is familiar with the Maryland Medical Fee Guide. They are also painfully aware that this system of determining the level of reimbursement for health care covered by the Maryland Workers' Compensation Law has not been updated in many years. Furthermore, many recent innovations in workplace health care are not included.
POLITICAL CONSIDERATIONS
Repeated attempts over the years to thoroughly update and reform the Fee Guide have been unsuccessful due to the natural conflict of interests that exist between payers and receivers that hampers the achievement of a politically viable consensus. Individual health care providers are understandably reluctant to assume the overall responsibility to speak for the entire workplace health care community. Providers would be concerned about the possible negative perception that such a visible role may create in the mind of employers and insurers on whom the provider is dependent for referrals. Without a strong and credible voice to offer well-conceived positions and persuasive advocacy, health care providers never achieve the essential "critical [political mass] in dealing with public policy makers on reimbursement related issues.
Beginning in 2002, MWHCA has attended meetings of the recently re-established Maryland Medical Fee Guide Revision Committee on behalf of the Maryland workplace health care community. The work of the Revision Committee is progressing and a final report is anticipated in the near future.
RBRVS
MWHCA is hopeful that the Revision Committee will recommend that Maryland adopt the Resource Based Relative Value System (RBRVS) for workers' compensation health care services. RBRVS, which is used to compensate, health care providers for services related to Medicare, is already in use in for workers' compensation in other states. If adopted in Maryland, MWHCA would work to assure that the levels of reimbursement are adequate to assure appropriate, timely health care for injured workers. It will also be necessary for MWHCA to monitor the ongoing review and updates to continually improve the effectiveness of RBRVS for compensation of workplace health care. For more information about RBRVS, see the following:
ADDITIONAL COSTS
One of the most important objectives in developing the RBRVS levels of reimbursement for workers' compensation is the need to incorporate the additional and increased costs of providing health care under Maryland's Workers' Compensation Law. Primary among the considerations for the higher cost of providing workplace health care are the difficulty and delays in collecting health care reimbursement as well as the extensive, additional administrative requirements related to treatment provided in accordance with the Maryland Workers' Compensation Law.
EQUITABLE COMPENSATION
Any calculation of compensation for health care required under the Maryland Workers' Compensation Law must consider the requests for detailed documentation of the nature and extent of injuries, ongoing updates on the medical progress, extensive evaluation for specific treatments and the requirement that health care providers participate in the adjudicative process to justify treatments, recommendations and evaluations. MWHCA will make every effort to see that the reimbursement for health care provided under the Maryland Medical Fee Guide is not placed below the amounts paid for medical care provided under other health insurance coverage such as Medicare and private health insurance where the additional documentation mentioned above is not required.
PROMPT PAYMENT PROBLEMS
In addition to its advocacy related to the Fee Guide Revision Committee's work, MWHCA will address the significant problems related to payments for workplace health care, referred to as "prompt payment" losses, which are estimated in the many $ Millions per year in Maryland.
Unlike most other areas of health care, injuries for which health care is provided under the workers' compensation statute are subject to review and coverage is too often denied, leaving the health care provider with receivables that are difficult to collect. Additional administrative requirements to process such payments, combined with the significant delay of payment as well as the substantial number of accounts that providers must write-off, significantly increases the cost of providing health care under the workers' compensation law.
MWHCA would prefer to have the "prompt payment" losses factored into the revised Fee Guide; however, the Maryland Workers' Compensation Commission has indicated a desire to deal with this concern separately. In order to resolve the inequities related to prompt payment, MWHCA will be required to develop extensive research to demonstrate the extent of the problem, develop a solution and monitor progress toward resolution.
If MWHCA efforts are sustained…
Maryland will adopt RBRVS with equitable payment provisions the ongoing revisions of which will be adopted by the Maryland Workers' Compensation Commission. Prompt payment issues will receive serious consideration and chronic problems will be resolved. In the workplace health care providers can be assured of adequate compensation and injured workers will have readily available, competent health care.
If workplace health care providers do not take concerted action…
The Maryland Workers' Compensation Commission will likely adopt a version of RBRVS that will not resolve the current inadequacies and the workplace health care providers in Maryland will likely be limited to those able to make optimum use of large economies of scale in the delivery of health care. Injured workers will find it increasingly difficult to obtain readily available health care for work related injuries. In addition, when the payment for health care is unreasonably delayed or denied, the injured worker may be exposed to liability for the payment of the health care in question.
