Texas’ silent PPO legislation

As the biennial Texas legislative session nears its end, it looks like the legislature may pass a bill that would have a dramatic effect on workers comp PPO networks. According to WorkCompCentral (subscription required): “HB 223 would regulate “discount brokers” … Continue reading

Why PPO litigation is increasing

PPOs, or Preferred Provider Organizations, have been around for a couple dozen years. They are networks of credentialed (with varying degrees of rigor) doctors, hospitals, and ancillary providers that have agreed to provide lower rates for ‘members’ in return for … Continue reading

Rousmaniere on WC PPOs

Peter Rousmaniere has written a thoughtful, detailed, and quite accurate piece on the state of the workers comp PPO market. I recommend it highly.

Anything but simple

To the casual observer, the work comp bill review process is pretty simple: make sure the procedure codes are appropriate for the injury, compare the billed codes to the state fee schedule/allowable amount, apply any reimbursement rules, and you’re done. … Continue reading