This chapter focuses on the common theme that is brought up by some stakeholders within workers’ compensation – “Why is workers’ compensation not reimbursed at the same rate as group insurance?” Herein this author explains the difference from the perspectives of treatment provision, management, and clinicians as they relate to this topic. The perspective provided stems from the author’s experience at the “ground level” rather than from a top-down management point of view. Additionally, the differences will be explored in the form of responding to a question so that the complexity of such a topic can be more clearly understood.
For the past year, this author has been heavily involved in the revenue cycle and reimburse of all payers for a national physical rehabilitation company. The payers included group, Medicare, Medicaid, auto, personal injury and, of course, workers’ compensation. This responsibility covered a five state area and over 100 different group contracts. The result is a very non-theoretical but rather realistic perspective.