Yesterday, the North Carolina Court of Appeals issued another victory for North Carolina’s workers’ compensation system. Reversing a ruling by the Wake County Superior Court, the state Court of Appeals issued a unanimous decision supporting the qualification of ambulatory surgical centers as “hospitals” when applying fee schedules. While the case could be taken up by the North Carolina Supreme Court, this is a major win that maintains predictability and protects against increased workers’ compensation costs.

Two years ago, the North Carolina Industrial Commission (NCIC) first adopted a medical fee schedule for physicians and hospitals based on Medicare’s reimbursement model to bring North Carolina into alignment with neighboring states. Prior to this adoption, workers’ compensation costs for medical procedures in the Old North State were far higher than those in competing states – a hindrance to the state’s ability to attract and retain investment. A compromise made after years of hard work and negotiation, the original fee schedule rule was embraced by North Carolina’s business community, the North Carolina Hospital Association, the North Carolina Medical Society, workers’ compensation insurance companies, the North Carolina Advocates for Justice and the North Carolina Association of Defense Attorneys. However, despite the breadth of support for this fee schedule, the ambulatory surgical center industry challenged the commission’s ability to apply the rule to their facilities in court. This week’s ruling by the North Carolina Court of Appeals negates that challenge, ensuring that fees paid to ambulatory surgical centers will be in-line with other medical providers and median reimbursements by other states.

The NCIC’s adoption of this fee schedule was just one component of broader reforms that implemented comprehensive solutions to increase certainty and decrease employer costs in North Carolina’s workers’ compensation system. These reforms have been instrumental in reducing workers’ compensation costs for job creators year after year. In fact, the North Carolina Rate Bureau announced another rate reduction for 2018, this time by an average 12.5%. After signing onto an amicus brief, comments and letters in support of the fee schedule, we are pleased with the Court’s decision. North Carolina needs a workers’ compensation system that works for injured employees and their employers and we will continue to fight for reforms that strengthen our system.

Gary J. Salamido
Vice President, Government Affairs
North Carolina Chamber