By: Melinda Hayes, President and CEO, M Hayes
Interpretation today looks like case management did 30 years ago — no nationally required or accepted professional certifications and few standardized practice requirements. There is little oversight regarding fees and outcomes. As an industry, it is largely unregulated.
However, several recent regulatory and judicial decisions may signal a new regulatory environment in workers’ compensation. This year California saw a landmark administrative board decision, and the state is reportedly considering legislative changes regarding fees, reporting and professional qualifications. Additionally, Oregon and North Carolina have recently implemented fee and/or ethics rules.
On March 17, 2011, the California Workers’ Compensation Appeals Board, sitting as a whole (“en banc”), issued a very important decision on the issue of interpreter liens. In Guitron v. Santa Fe Extruders and State Compensation Insurance Fund, the Board determined that the workers’ compensation employer/insurer was obligated to pay for “reasonably required interpreter services during medical treatment appointments for an injured worker who is unable to speak, understand, or communicate in English,” and not just for medical-legal evaluations as the state fund had argued.
In the second part of its decision, the Board made it clear that the interpreter had the burden of proving “that the services it provided were reasonably required, that the services were actually provided, that the interpreter was qualified to provide the services, and that the fees charged were reasonable.” The Guitron decision can be accessed here.
Another indication of increasing regulation is seen in Oregon’s rules pertaining to billing for medical visit interpretation (Oregon Administrative Rules 436-009-0110 through 436-009-0145). These address choice of interpreter and fees and billing, among other things, and are fairly comprehensive. They can be accessed at the Oregon Workers’ Compensation Division website.
In North Carolina, the Industrial Commission clarified the role of interpreters through prohibiting observational summary reports that include but are not limited to information regarding conversations between the parties as well as information about the appearance of the injured worker. The panel said the summaries will be perceived as improperly assisting with management of the claim, and therefore, have adopted an official policy statement prohibiting such reports.
Several efforts to establish a national certification for healthcare/medical interpretation as well as nationally recognized standards of practice are underway. However, these may be difficult to implement because the industry is fairly fragmented, due in part, to the nature of its freelance service delivery.
As it evolved, the case management industry developed requirements for credentialing, practice standards and ethics through national case management credentialing groups as the profession developed in the insurance sector. Ultimately, many states established credentials for practitioners based on these professional certifications and licenses. As it has in case management, practice and professional standardization will ensure better service consistency and delivery.
Appropriateness of fees is another relatively unregulated area, and comp payers are beginning to scrutinize minimums and hourly rates. Establishing quality and reasonable cost should go hand in hand. Since using a field interpreter is so expensive, the industry will likely turn to telephonic interpretation just like it adopted telephonic case management. Wouldn’t it be better for the industry to create appropriate pricing standards than for states to impose regulations?
The trickle of initial regulation and judicial decisions surrounding interpretation portends more to come.
About Melinda Hayes
Melinda Hayes is the President and CEO of M Hayes, a leading managed care company she founded in 1999. With close to 30 years of managed care experience, Hayes grew the company into a national provider serving the largest payers in workers’ compensation. She received the Future 50 Award from SmartCEO magazine and her company was recognized by the Baltimore Business Journal as one of the area’s largest women-owned businesses in both 2009 and 2010. Hayes may be reached at email@example.com.
About M Hayes
M Hayes is a leading managed care company, providing nationwide services to workers’ compensation insurance companies, third party administrators, and self-insured entities. Known for innovation and delivering the best solutions to its clients, M Hayes provides telephonic and field medical case management, including catastrophic and bilingual, vocational case management, interpretation and translation, life care planning, and litigation management services to more than 350 clients that represent predominately workers’ compensation insurance risk. M Hayes has been named as one of the top ten largest case management providers by Business Insurance for the last four years.