Workers' Compensation Services

Completed referral form and copies of existing medical records for this injury. Our spine surgeons require a MRI. If patient has not had a MRI, our physicians will provide an order so it can be completed prior to the appointment. We do not accept work comp referrals from USDOL. Dr. Rambo does not accept workers’ compensation referrals.

No. The carrier or adjuster must make the appointment and provide requested information and authorization.

Most of our physicians require a review of the records before accepting an IME or 2nd opinion. We will contact you to schedule and make payment arrangements when the physician accepts the appointment.

Neuro/Spine Request:
Submit online Referral Form and indicate you are seeking an IME or 2nd Opinion. Please indicate any specific issues you need to be addressed in the notes field. Submit MRI report; Midlands OrthoNeuro Spine Form; all records. Imaging discs should be brought to the appointment.

Ortho Request:
Submit online Referral Form and indicate you are seeking an IME or 2nd Opinion. Submit all records; images if available (disc and reports – may be brought to appointment).

Click here for more information. Key takeaway: Neurologists offer front-line treatment for chronic headaches and will refer to a neurosurgeon if underlying conditions warrant.

An additional year of sub-specialty training following residency. Fellowship training provides a high level of skill in a specialty area. Foot and ankle surgery, total joint replacement and hand surgery are all sub-specialties of orthopedics. Every orthopedist, for example, is not equally skilled in all aspects of orthopaedic surgery. Complex repair of different body parts on one patient may require different surgeons within the same practice for best results.

No. A direct correlation exists between the strength of the magnetic field and the quality of images produced. The magnetic field is measured in Tesla units. Most orthopedists and neurosurgeons consider a 1 Tesla unit as minimally acceptable to produce images of appropriate diagnostic quality. Workers’ compensation imaging networks frequently direct MRIs to facilities with magnets less than 1 Tesla resulting in inadequate images that must be re-done. This duplication delays treatment and increases expense.

Frequently employers refer all work comp injuries to an urgent care or primary care specialist because they believe this process mitigates expense even though the SC work comp rate schedule is the same for primary care visits and specialty visits.

As musculoskeletal (MSK) specialists, we frequently receive referrals as many as 30 days after an injury. Prior to that time, inadequate or inappropriate imaging has often been ordered in addition to therapy that is not being supervised by a MSK physician. Often, the MSK evaluation reveals a need for surgical repair that could have been performed much earlier. At this point, surgery may be more complex, and recovery may be longer because of delay in treatment.

Many employers believe that referring directly to a MSK specialist may result in a rush to potentially unnecessary surgery. Practices like ours offer comprehensive MSK services precisely to prevent that outcome. We have non-operative MSK providers who are well-equipped to evaluate injury and offer conservative care like therapy when appropriate. If conservative treatment fails, transition to a surgeon can occur seamlessly with no delay in care to impede the outcome.

Our practice is eager to collaborate with employers to offer MSK urgent care services customized for their needs. Contact AnnMargaret McCraw to discuss this opportunity.

As one of few independent medical practices remaining in the Columbia area, Midlands Orthopaedics & Neurosurgery relies on its affiliated Ambulatory Surgery Center (ASC) to offer consistently convenient, efficient, high-quality, and lower cost care to all patients. While our surgeons do operate at local hospitals when that setting is needed, most surgery performed by our practice is well-suited to an ASC setting.

Infection risk is reduced in the ASC setting simply because otherwise healthy patients presenting for an orthopedic or spine surgery are not comingled with patients who are fighting infectious disease as often occurs in hospital settings. Patient convenience is enhanced as access to the freestanding ASC does not require navigating a hospital complex or parking garage.

According to the Patient Safety Network, 2-4% of all inpatient surgeries in the US result in surgical site infections. Our cumulative infection rate for all surgeries performed from 2006-2019 (40,222) is 0.27%.

Joint Replacement Cumulative Infection Rate 2012-2019 (2,690 surgeries): 0.19%

Advanced Spine Cumulative Infection Rate ( 802 surgeries) Cervical, Lumbar & SI Joint Fusions, Cervical Disc Replacements and Spinal Cord Stimulator Placements 2012-2019: 0.26%

Our ASC is accredited by Accreditation Association for Ambulatory Health Care (AAAHC) and received the 2020 Health Value Award for Outpatient Surgery Programs from the Validation Institute.

SC Workers’ Compensation Facility Payment Methodologies & Midlands OrthoNeuro ASC Decision Tree

The number of stakeholders. Physicians may receive inquiries from and have obligations to as many as 6 parties for one work comp episode of care: patient, employer, adjuster, nurse case manager, carrier’s attorney and patient’s attorney.

Often, the communication among these parties is not well-coordinated; thereby increasing the administrative complexity of providing workers’ compensation care.

Complexity of injury. Injured workers require some of the most complex repair and surgical skill of all patients we treat. Re-injury is prevalent in some industries, and repair is always more difficult the second or third time.

Authorization process and amount of paperwork. Each service rendered for a work comp patient must be approved by an adjuster. Most health insurance plans require authorization for facility-based procedures, but not for office-based services; and those authorizations can frequently be obtained electronically which is rarely an option in work comp.

Work status forms and dictation. This information must be submitted to multiple parties for each visit. Patients, employers, nurse case managers and adjusters may all want copies of these documents. For other types of patients, a work note is only provided to the patient directly.

Bill processing. Dictation must be submitted with each work comp bill requesting payment in addition to providing it to the adjuster. The adjusters and bill review teams are often siloed and do not share information. Health insurance plans generally require dictation upon request only.

Additionally, the physician is rarely pro-actively notified when a claim is settled or deemed to be non-compensable. We discover it when receive a claim denial often weeks after a settlement or dismissal. Meanwhile, a claim for the same service will be denied by private insurance until written proof of denial by the comp carrier is provided.

Questionnaires. 14B forms and other questionnaires are routinely requested by adjusters, nurse case managers and/or attorneys. Health insurance plans rarely require questionnaires as a supplement to dictation.

Payment. Because the SC Workers Compensation Commission sets the maximum allowable payment rates for physicians and facilities, we are not able to negotiate rates directly with the purchaser that exceed those limits. In recent years, those rates have not kept pace with the cost of delivering workers’ compensation care, particularly considering the additional administrative burdens described above.

Precisely because these complexities exist exclusively in workers’ compensation, our practice employees a dedicated team of representatives to coordinate treatment with the appropriate stakeholders.

No. SC’s state mandated workers’ compensation rate schedule is one of the lowest in the nation and does not provide adequate profit margin to make additional discounts possible.

Workers’ Compensation Research Institute’s (WRCI) Medical Price Index for Workers’ Compensation 11th Edition (2019) indicates that SC’s workers’ compensation medical price index ranks 35th of 36 states included in the analysis, where 1 is the highest rate and 36 is the lowest.

SC’s work comp rates as a premium of Medicare: 140%

SC’s growth rate in prices paid for workers’ compensation medical professional services 2008-2018: -2% Only 3 other states in the analysis have negative growth rates over this period.

Despite the low payment rates, meeting the expectations of workers’ compensation stakeholders requires a dedicated team of administrative professionals. The following statistics are specific to Midlands OrthoNeuro for calendar year 2019:

• Practice personnel cost per work comp claim/bill: $15.49
• Practice personnel cost per all other claims/bills: $6.11
• Our practice personnel cost to support workers’ compensation is 250% more per claim than all other payer types.

We encourage workers’ compensation stakeholders to advocate for a more competitive medical services rate schedule to ensure that high quality medical providers will remain engaged in the system.