There is a great deal of misinformation and confusion related to the treatment of an injured worker. Here are a few bits of key information that a medical provider needs to know to assure that it is treated the way the law envisions: No Virginia has no set fee schedule for workers’ compensation medical reimbursements….

It may surprise medical providers to learn that, whenever they submit bills to workers’ compensation insurance companies, there are other companies that spring into action hoping to take a piece of the action. The two primary businesses that make money from the handling of medical bills in the workers’ compensation system are PPO networks and…

Any medical providers with billing claims pending before the Virginia Worker’s Compensation Commission will want to follow closely the potential actions by Congress in dealing with CMS payment rates. That is because many workers’ compensation repricing network contracts allow the networks to base their worker’s comp reimbursements upon CMS rates for each procedure code. Right…

Most worker’s compensation provider networks are pretty much interchangeable.  Each has a published directory of those medical providers who have signed contracts to join the network, thereby agreeing to allow payors to take steep discounts on the providers’ billings.  The networks give no consideration to quality of care, nor to how the providers save the…

I have been asked numerous times over the years, “What is the difference between all the disability programs for injured workers?” Let’s talk first about the workers’ compensation system. In Virginia any employer with 3 or more employees is required to carry workers compensation insurance. The policy rates are determined by the industry in which…

In the world of the workers compensation industry, many times the parties involved enter into a game of chess.  The game has many of the traditional elements to include a battle to see who wins. There are many pieces involved in the game from the insurance company, medical provider and patient.  The insurance company wants…

In workers’ compensation cases, many parties try to get their fingers into the proverbial pie. Often this leads to confusion as to who has the power to order what, or who must follow directives from whom. In Virginia’s system, the roles typically played by the various parties may be summarized as follows: The Insurance Company…

On occasion a Virginia-based medical provider will accept a patient who is receiving workers’ compensation benefits under a case pending in another state.  This can happen not only in areas that border other states, but also when a previously injured worker moves into Virginia.  The Virginia-based medical provider may assume that reimbursement for treatment should…