Medical claims paid by workers’ compensation insurance among US Medicare beneficiaries, 1999–2016

Details

• Alternative Title:
  Am J Ind Med
• Personal Author:
  Kurth, Laura ; Casey, Megan ; Chin, Brian ; Mazurek, Jacek M. ; Schleiff, Patricia ; Halldin, Cara ; Blackley, David J.
• Description:
  Background:
  
  Workers’ compensation claims among Medicare beneficiaries have not been described previously. To examine the healthcare burden of work-related injury and illness among Medicare beneficiaries, we assessed the characteristics, healthcare utilization, and financial costs among Medicare beneficiaries with claims for which workers’ compensation was the primary payer.
  
  Methods:
  
  We extracted final action fee-for-service Medicare claims from 1999 to 2016 where workers’ compensation had primary responsibility for claim payment and beneficiary, claim type, diagnoses, and cost information from these claims.
  
  Results:
  
  During 1999–2016, workers’ compensation was the primary payer for 2,010,200 claims among 330,491 Medicare beneficiaries, and 58.7% of these beneficiaries had more than one claim. Carrier claims submitted by noninstitutional providers constituted the majority (94.5%) of claims. Diagnosis codes indicated 19.4% of claims were related to diseases of the musculoskeletal system and connective tissue and 12.9% were related to disease of the circulatory system. Workers’ compensation insurance paid $880.4 million for these claims while Medicare paid $269.7 million and beneficiaries paid $37.4 million.
  
  Conclusions:
  
  Workers’ compensation paid 74% of the total amount to providers for these work-related medical claims among Medicare beneficiaries. Claim diagnoses were similar to those of all workers’ compensation claims in the United States. Describing these work-related claims helps identify the healthcare burden due to occupational injury and illness among Medicare beneficiaries resulting from employment and identifies a need for more comprehensive collection and surveillance of work-related medical claims.
  
  
• Subjects:
  Aged Article Female Humans Insurance, Health, Reimbursement Male Medical Claims Medicare Occupational Diseases Occupational Injuries Patient Acceptance Of Health Care United States Work-related Injuries Workers' Compensation Workers’ Compensation

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• Source:
  Am J Ind Med. 64(3):185-191
• Pubmed ID:
  33428262
• Pubmed Central ID:
  PMC8284999
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Place as Subject:
  United States
• Volume:
  64
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:bd0169355c03aac8e59de444a5ec1e8afdeda13d70632f5c8280ddd57fa377c6
• Download URL:
  https://stacks.cdc.gov/view/cdc/114963/cdc_114963_DS1.pdf
• File Type:
  [PDF - 479.68 KB ]