Workers Compensation Rates

Workers Compensation (Work Comp) rates are included in the scope of MRFs when there are specific negotiated rates in contracts between the provider and Work Comp insurers. These rates can vary significantly based on the state-specific Work Comp programs and the types of services rendered.

Basis of Rates

State Work Comp Fee Schedules: Work Comp rates often align with state-specific fee schedules. These schedules may include different rates based on the type and severity of the injury as well as the specific services provided.

Other Methodologies: In some cases, Work Comp rates are based on methodologies unrelated to state fee schedules, potentially involving other negotiated agreements with insurers.

Inclusions and Carve-outs

Detailed Benefits: The list of covered services under Work Comp is typically extensive and detailed, making it challenging to calculate a standard rate for all services. There may be separate rates for specialized services, such as physical therapy or surgical procedures, that are considered in scope or out of scope.

Algorithms: When rates are based on complex adjustments or state-specific fee schedules, Turquoise includes these details in the algorithm field of the MRF. This helps to capture the nuances of Work Comp reimbursement methodologies and ensures compliance with CMS requirements.

By accurately identifying and including the payable services and relevant details, Turquoise ensures that the MRFs reflect the negotiated Work Comp rates, promoting transparency and aiding in compliance with regulatory standards.