Research
Changes in WC Physician Reporting Under the RBRVS Fee Schedule: Initial Results
The average amount paid for all California WC physician reports fell 37% from $26.13 in the 1st quarter of 2013 to $16.53 in the 1st quarter of 2014 as the state began to transition to the new RBRVS Fee Schedule, but that decline was due to changes in the underlying E&M services in the schedule and not a decrease in the fee schedule amounts assigned to report codes.
California WC Claims Administrator UR Audit Results: 2009 – 2013
A review of DWCs 2009-2013 UR audit results show claims administrators had an average performance rating of more than 97% over the 5-year period.
IMR Outcomes in California Workers Comp
A CWCI analysis of 2014 IMR decisions suggests that the medical dispute resolution process mandated by SB 863 is working to assure that treatment provided to California injured workers meet evidence-based medicine standards and is providing a needed check against unnecessary and potentially harmful tests, surgeries, drugs and procedures.
California WC Independent Medical Review: 1st Quarter 2015 Outcomes
An analysis of 2015 independent medical review (IMR) decisions from the first quarter of 2015 shows no significant decline in IMR volume in the first three months of this year, even though the independent medical reviewers continue to concur with the utilization review (UR) physicians denial or modification of treatment in about 90 percent of the cases.
ICD-10s and the WC System
A new analysis examines the history, form and function of the ICD-10 classification system for healthcare delivery, which takes effect October 1 for all health care systems in the U.S. – including California workers' comp.
California's Proposed WC Formulary: Preliminary Review of Preferred and Non-Preferred Drugs
A CWCI Spotlight Report that uses data on 1.2 million prescriptions dispensed to California injured workers in 2014 to model the impact of the proposed WC prescription drug formulary released by the DWC on August 26, 2016.
