Workers Compensation Fee Schedule Expert witness

State workers compensation fee schedules often include vague and ambiguous language for a portion of the fee schedule.  For example fee schedules may include language such as:

  1. Workers compensation fee schedule payment at the usual and customary rate.  One must then ascertain what usual and customary means in the context of the medical service, medication or device
  2. Workers compensation fee schedule payment at the Medicare rate.  One may find that Medicare is also vague or ambiguous or may not cover the medical care, medical device, or drug

Workers compensation expert witness opinions regarding usual customary and reasonable (UCR) charges under worker’s compensation fee schedule, billing practices, medical coding, clinical documentation require an understanding of specific services for which there may be unique billing codes for billable services and devices such as:

  1. Ambulatory surgery center charges
  2. Diagnostic imaging charges
  3. Dialysis and related medications
  4. Durable medical equipment, prosthetics, orthotics and supplies (DMEPOS)
  5. Hospital inpatient stay charges
  6. Pathology and laboratory charges
  7. Pharmaceutical charges for over the counter or prescribed drugs and compounds
  8. Physician services charges (‘professional fees’)

We can assist our clients in deciphering fee schedules and resolving vague or ambiguous fee schedule language by providing opinions on usual customary and reasonable charges or usual customary and reasonable payments in the community, state or based on national data and analysis.