Will Virginia Adopt a Medical Fee Schedule?

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Authored by Megan B. Caramore

The Commission and Legislature appear to be exploring the possibility of a medical fee schedule for the Commonwealth’s workers’ compensation system.  Virginia currently has no fee schedule and relies on the usual and customary rates of providers in various geographical areas.  Under Virginia law, it is difficult to prove that a providers rates are unreasonable or exceed the usual and customary rates for the service provided in that area.  But change may be in the works!  Passed on March 23, 2015, HB 1820 provided, in part, that:

[T]he Workers’ Compensation Commission shall convene a work group of stakeholder representatives of employers, health care service providers, claimants, and insurers to advise and assist the Commission in (i) reviewing, analyzing, and comparing information contained within and reports on all possible databases containing workers’ compensation or health care data for medical services rendered in Virginia, (ii) reviewing, analyzing, and comparing information contained within and reports on how similar databases are used for the establishment of the pecuniary liability of the employer in other states, and (iii) making findings or recommendations as to how the databases reviewed and the contents thereof may serve to enhance or replace Virginia’s current mechanisms for establishing the pecuniary liability of the employer. The Workers’ Compensation Commission shall report its findings and recommendations to the Chairmen of the House and Senate Commerce and Labor Committees by December 15, 2015.

While there have been failed attempts to adopt a fee schedule in the past, most recently in 2013, the issue appears to be back under consideration.  Most recently, a meeting of the stakeholders was scheduled for December 21, 2015 at the General Assembly Building.  Stay tuned for additional information on this possible significant change to Virginia law.

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