Since Florida Workers Compensation allows payment above the fee schedule, can judges discount a doctors testimony if he was paid above the fee schedule?
Judges cannot discount a doctor’s testimony if he was paid above the fee schedule when the injured worker was furnished medically necessary treatment and care through a managed care arrangement contractual agreement. As a point of clarification, an insurer does not have to use the Health Care Provider Fee for Service Reimbursement Manual as a benchmark when negotiating a contract with a health care provider in a managed care arrangement. When the terms of payment with a provider within a workers’ compensation managed care arrangement are established by an insurer, the contract levels of reimbursement may be provider specific or based on any national treatment standards and guidelines for authorization and reimbursement of medically necessary services. However, the contractual terms must be mutually accepted by both parties.
Related Questions
- When using the Workers Compensation Board (WCB) Medical Fee Schedule to bill, are health providers bound by the preauthorization requirements contained in the fee schedule?
- Since Florida Workers Compensation allows payment above the fee schedule, can judges discount a doctors testimony if he was paid above the fee schedule?
- How can I find another states workers compensation fee schedule?
