Worker's Compensation: How Do Orthopedic Surgeons Fare?

Introduction: Negotiable reimbursement for patients with workers’ compensation (WC) has not been investigated previously. Our study investigated characteristics of the revenues (to individual surgeons) associated with these WC patients.

Methodology: All WC patient encounters in our ortho­pedics department from March 1, 2007 through June 30, 2008 were included. The revenue yield (final payment as percentage of original charge billed) and the total time to payment (time to process bill plus time for payment) were compared according to visit type, subspecialty, insurance payor, and number of Current Procedural Terminology (CPT) codes per encounter.

Results: Clinic visits (n = 816) comprised 65% of total patient encounters, and procedural encounters comprised 35% (n = 436). The overall revenue yield for WC was 49%, compared with 31% for Medicare. Yields for spine proce­dures (37%) were significantly lower than for other subspe­cialties, which ranged from 54% to 64% (P = .002). Time to payment was higher for procedures than clinic visits (101 vs 62 days, P<.0001), primarily due to increased time to post charges. Finally, increased time to payment was asso­ciated with increasing number of CPT codes per encounter.

Conclusion: Negotiated revenues from WC are greater than from Medicare but vary according to subspecialty and payor (with spine having the lowest yield). Time to payment displays considerable variation as well, espe­cially in time to post charges.