Connecticut Fee Schedule for Hospitals, ASCs Takes Effect


Connecticut’s Medicare-based fee schedule for workers’ compensation takes effect April 1.

The new fee schedule pays 174% of Medicare for in-patient care, 210% outpatient care and 195% for ambulatory surgical centers.

This is touted as a cost savings measure. Does this mean prior to April 1 Connecticut hospitals and ambulatory centers were getting more?

So much for managed care contracts these days and another reason why Cost Plus Insurance, Medicare Plus reimbursement schemes are taking the market by storm. Payers are “mad as hell and not taking it anymore……” – Homer G. Farnsworth, M.D.

April 10, 2015

Connecticut’s Medicare-based fee schedule in workers’ compensation for hospital inpatient, hospital outpatient, and ambulatory surgical center (ASC) services went into effect April 1.

Previously, there were no facility fee schedules in Connecticut and employers were liable for the hospitals’ prevailing charges unless the payers have negotiated discounted rates with the hospitals, according to the National Council on Compensation Insurance (NCCI).

Before, there was no facility fee schedule in Connecticut, though there has been one for physician fees, said Laura Backus Hall, NCCI’s state relations executive for Connecticut.

“A part of the facility fee schedule is that hospital outpatient services shall be reimbursed at 210 percent of Medicare’s outpatient fee schedule. That’s one of the features,” Hall said. “Another is that ambulatory surgical center services are to be reimbursed at 195 percent of Medicare’s outpatient fee schedule. And another feature is hospital inpatient services shall be reimbursed at 174 percent of Medicare’s Inpatient Prospective Payment System (IPPS).”

This new facility fee schedule is expected help lower medical costs, as reflected by the recently approved NCCI filing for decreases in advisory loss costs and assigned risk rates.

The NCCI made a law‐only filing in February to reflect expected reduced medical costs in connection with the implementation of the official fee schedule for hospitals and ambulatory surgical centers pursuant to Public Act 14‐167 and established by the Connecticut Workers’ Compensation Commission (WCC). The filing for an overall -2.3 percent change for pure premium loss costs and an overall -2.3 percent change in assigned risk rates were approved in March and went into effect April 1 for new and renewal policies.