TRENTON, N.J., April 8 – Proposed seven months ago, the new medical fee schedule is still being reviewed by the state Insurance Department with no forecast on when it will be enacted or if it will be amended.

Since it was proposed last September, the department has received 305 comments and suggestions from the interested parties, and those comments are still being reviewed.

The details of whether those comments are for or against the schedule are not being made public and wont be until the department reveals whether changes will be made to the origi-nal proposal.

Defining the New Schedule

The proposed schedule would cover 1,000 medical procedures for injuries suffered in automobile accidents " making it more than 10 times larger than the existing schedule that sets costs for 92 procedures. If enacted, the schedule would be the first major change to costs in five years. It is based on Medicare facility fees at 130 percent of the 2006 Medicare base rates in the New York metropolitan area. Any procedure not listed in the fee schedule is resolved by agreeing to the reasonable and prevailing fees of 75 percent of the practitioners within the region.

The new fees would be set for facilities in North Jersey and South Jersey, with the fees slightly lower in the South than in the North.

The North consists of 11 counties: Bergen, Essex, Hudson, Huntertown, Middlesex, Morris, Plastic, Somerset, Sussex, Union, and Warren.

The Souths 10 counties are: Atlantic, Burlington, Camden, Cape May, Cumberland, Gloucester, Mercer, Monmouth, Ocean, and Salem.

Department, Medical Society Debate Benefits

When adopted, the schedule will affect automobile insurance rates because medical costs represent a significant factor in setting premiums.

The department originally wanted to close the comment period by November, but because of the volume of comments, the time frame was extended to the end of the year.

The department had hoped the new schedule would end the bickering between insurers and doctors on how much is to be paid for treatment.

However, the New Jersey Medical Society and some legislators are opposing the new schedule. The medical society, representing 6,000 physicians, favors keeping the existing system of setting costs based on the usual customary and reasonable fees charged by most physicians in a given area.

The society contended that there would be drastic cuts in reimbursement for services, and that the schedule would lower the number of physicians willing to take calls to treat accident victims. The society also said that hospital costs could increase.

The department contends that the new fee schedule will benefit the consumers. The existing system of determining fees, stated the department, is time-consuming and costly because of arbitration proceedings now being used to determine what should be paid. A department statement explains the new fee schedule will enable insurers and providers to streamline the billing and paying of claims, reduce the incidence of billing abuse and fraud, and cut down on the time required to pay claims.

The department declared that the new coding system will prevent disputes about unbundling services and will lead to efficient processing of claims as well as alleviating administrative burdens on providers and insurers.

Officials feel that even though many of the fees listed in the new proposal are higher than those of five years ago, the increase will be offset by the savings on the costs of disputes.

The new schedule is favored by most car insurance companies, including the New Jersey Insurance Council representing companies handling 90 percent of the car insurance business in the state.

Assemblyman Neil Cohen, (D-Union) Chairman of the Assembly Insurance Committee, has introduced legislation that would keep the present fee schedule instead of the one being proposed by the department.