This study continues to monitor the effects of major legislation, House Bill (HB) 709, passed by the North Carolina legislature in 2011. It includes claims occurring up to slightly more than four years after the income benefit provisions of HB 709 became effective, so it may provide a look at changes in patterns of some indemnity components that could be related to those provisions.

New fee schedule rules became effective in 2015, with reimbursement based on a percentage of Medicare. Phased-in decreases in reimbursement for hospitals and ambulatory surgery centers (ASCs) went into effect in April 2015, while increases in reimbursement for nonhospital (professional) services became effective in July 2015. Those changes are partly reflected in the medical data reported, up to 12 months of experience under the hospital and ASC fee schedules and up to 9 months of experience following implementation of the nonhospital fee schedule.

The study compares North Carolina’s performance with 17 other states (Arkansas, California, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Louisiana, Massachusetts, Michigan, Minnesota, New Jersey, Pennsylvania, Texas, Virginia, and Wisconsin), focusing on income benefits, overall medical payments, costs, use of benefits, duration of disability, litigiousness, benefit delivery expenses, timeliness of payment, permanent partial disability, temporary total disability, and other metrics.

The study also examined how these system performance metrics have changed, mainly from 2010 to 2015, for claims at various claim maturities. Claims with experience through 2016 for injuries up to and including 2015 were analyzed. In some cases, a longer time frame is used to supply a historical context for key metrics.

Monitoring the North Carolina System: CompScope™ Benchmarks, 17th Edition. Carol A. Telles. April 2017. WC-17-12.

Copyright: WCRI