This study examines medical payments per claim, prices, and utilization for various types of services by nonhospital and hospital providers in North Carolina, and compares them with 17 other states. It also examines how these metrics of medical costs and care have changed, mainly from 2014 to 2019, for claims at an average of 12 months of experience.

The data in this report reflect most of the effects from major changes in medical reimbursement rules that became effective in 2015, with reimbursement based on a percentage of Medicare. Those changes, along with interim fee schedule changes in 2013, targeted a key cost driver of workers’ compensation claims in North Carolina—hospital costs.

Claims with experience through 2020 for injuries up to and including 2019 were analyzed. In some cases, a longer time frame was used to supply historical context. Information from other WCRI studies was also included to provide a more complete picture of the system in North Carolina compared with other states.

The results we report include experience on claims through March 2020, at the very beginning of the coronavirus (COVID-19) pandemic. The study, therefore, provides a pre-COVID-19 baseline for evaluating the impact of the virus on workers’ compensation claims. 

CompScope™ Medical Benchmarks for North Carolina, 22nd Edition. Carol A. Telles. October 2021. WC-21-35.

Copyright: WCRI