There’s yet another reason for work comp payers to pay a lot more attention to surgical implant pricing – CMS has reserved the right to use its own methodology if it finds the payer’s methodology lacking.
WorkCompCentral reported piece [sub req] on “>today “if the workers’ compensation medical set-aside proposal includes the cost of an implantable device but does not include enough of the CMS required cost information about the device – and it is determined an implantable device such as a spinal cord stimulator is needed – CMS will use its own methodology to determine the cost of the device.”
CMS’ methodology is discussed here. (scroll to bottom of page and click on “august” download)
The folks at WorkersCompInsider have an excellent piece on implants and motivations of (some of) the physicians that use them.
I doubt the ‘look at what these cost us in the past’ methodology is going to fly with the good folks at CMS. They will certainly want something more substantial, something based on actual cost and not conjecture and what was paid in the past.
btw, WorkCompCentral is one of the go-to sources for comp-related information and news.
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