Workers’ comp has plummeted to a new low in payers’ relentless attempts to deny fair payment to the doctors who treat injured workers.

The Zenith’s recent effort to pay clearance-bin prices for medical care for an injured worker is one of the most egregious (and laziest) daisyNews has ever seen.

We didn’t think anyone could top the “Negotiation Proposal” ESIS recently sent to a California provider offering to pay 45% of the state fee schedule in exchange for “priority processing.” But along came Zenith with a formal offer to pay $400 for care worth over $1,200, in exchange for literally nothing.

Providers must be on high alert when treating Zenith and ESIS injured workers, as these payers may send “offers” to drastically underpay your practice.

This aggressive payment tactic represents the state of workers’ compensation. Instead of receiving the correct fee schedule payment for treating injured workers, doctors receive insulting spam letters like the one below.

Providers beware: you are a target.

Zenith “Letter Agreement” Grants Insurer 69% Discount

A daisyBill physician sent Zenith a bill for a Durable Medical Equipment (DME) procedure code, L3960.  California’s workers’ comp fee schedule pays $1,296.32 for the shoulder elbow wrist hand orthosis (SEWHO) the physician furnished.

Rather than paying the doctor, Zenith responded by sending the “Letter Agreement” below. Without a hint of irony, the agreement states (emphasis ours):

“Provider has agreed to accept $400.00, less any applicable network discount, as payment in full from Zenith for all Services provided to the Injured Worker.”

Several things make this letter somehow equal parts disturbing and laughable. The amount Zenith is offering the doctor is

• 31% of the amount allowed by state fee schedule, and
• 47% of the amount allowed by Medicare for the DME

Worse, even while offering to pay 31% of the amount due, Zenith reserves the right to apply any network contracts it can scrounge up to discount the reimbursement further.

The letter also declares that Zenith can “withdraw or modify” or “void” the agreement if Zenith determines that the offer Zenith concocted was “based on incorrect information.”

Give ESIS credit; at least its “Negotiation Proposal” pretended there was a benefit to the provider by offering “priority processing” and payment within 14 days (while omitting the fact that payment was legally due faster than that).

Zenith couldn’t even offer this physician the illusion of an incentive for its deranged payment offer.

Coder Decides Discount Rate?

The cherry on this fail-cake is the signature page, where we see exactly who the offer is from: a Certified Professional Coder (CPC) working on behalf of Zenith.

Yes, Zenith has medical billing coders deciding what (seemingly random) amounts physicians should receive for providing medical care to injured workers.

Breakthroughs can’t come without someone willing to push boundaries.

As payers look for new and innovative ways to enrich themselves by sucking revenue out of medical practices, bold visionaries like Zenith show us what’s really possible when a sense of shame is no obstacle.

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