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 The Compass…Glen's blog on the state of the industry
July 12
2010
IL WC Updates Medical Fee Schedule
As indicated in our previous industry update, the Illinois Worker’s Compensation Commission considered, and now implemented, significant changes to the medical fee schedule. The official word from the IWCC follows:
Emergency rules filed on implants, ASTCs
On July 6, 2010, emergency rules took effect that change the reimbursement method for implants and add accredited Ambulatory Surgical Care Facilities (ASCFs) to the ASTC fee schedule. The Commission filed the emergency rules with the Illinois Secretary of State for publication in the Illinois Register. Simultaneously, the Commission filed the same language to go through the normal rule-making process.
The amendment makes two changes to Section 7110.90:
1. It changes the reimbursement method for medical implants from 65% of normal charge to 25% over the manufacturer_s invoice price less rebates, plus actual and customary shipping costs incurred for the implant.
2. It provides that Ambulatory Surgical Care Facilities (ASCFs) accredited by AAAASF, JCAHO, AAAHC are eligible for reimbursement under the ASTC fee schedule. Previously, the rule said the ASTC fee schedule applied only to Ambulatory Surgical Treatment Centers licensed by the Illinois Department of Public Health.
Treatment on or after 7/6/10 should be paid according to these new rules.
May 21
2010 IL WC Medical Fee Schedule Continues to Evolve
The Illinois Worker's Compensation Commission and Medical Fee Advisory Board (MFAB) continue to make steady progress in the development and maintenance of the medical fee schedule. There are two major changes in the works relate to implants and Ambulatory Treatment Centers (ASTC's). Regarding implants, a rule change is being proposed that would take the current policy of paying these items at "65% of charges" and instead have these items paid at "25% above the net manufacturer’s invoice price less applicable rebates, plus actual reasonable and customary shipping charges." It is hoped that this change will eliminate concern over the hyper-inflated mark up of implants in surgical cases.
Currently, the IL fee schedule only recognizes ASTC's licensed by the Illinois Department of Public Health (IDPH). The Commission is proposing a rule change that would also include ASTC's that are not licensed by IDPH, but have obtained other certifications/accreditations demonstrating that they are safe and qualified facilities. Glen Boyle is assisting the Commission in writing the rules for both of these changes – and these will be presented to the MFAB at an August meeting.
Feb 15
2010 Glen Boyle To Speak in Springfield
Glen will be speaking before the Springfield Area Physician Office Staff Group on March 16th. Health Care Issues in a Struggling Economy, and How They Could Impact Worker's Compensation in the State of Illinois: Current Discussions on WC Utilization Review and the Medical Fee Schedule.
December 3
2009 Recent IL Seminars a Success!
Glen has recently completed 7 live seminars (Mt. Vernon, Collinsville, Springfield, Chicago X 2, Peoria, and Rockford) on the Illinois worker's compensation medical fee schedule. In addition, a widely attended Webinar was conducted on November 5th. A copy of the Chicago presentations can be obtained at the following link: Illinois Workers’ Compensation Commission Medical Fee Schedule Seminars (PPT) 8MB.
The seminars covered some tough issues and topics and we continue to work on answering questions and ironing out wrinkles in the fee schedule. Here is some of the recent feedback:
"Yes, it was VERY informative and definitely worth EVERYONE's time. You guys were great and I can't wait to able to download the PowerPoint presentation presented..More future Webinars would be appreciated, and I look forward to them…Thanks again!!!!!!" — Christopher, Medical Bill Review, Supervisor/Account Manager
Thank you for providing the training, we did find it beneficial. I wish more states would be as proactive and provide for training in regards to their fee schedules. Once I review the corrected power point presentation and updates on the fee schedule frequently asked questions, I will let you know if we have any additional concerns or need further clarifications.
Thank you for the learning opportunity.
I would like to take this opportunity to thank you and Glen for the very informative webinar. It helped clarify areas of confusion. — Debra, Provider Bill Audit Nurse Reviewer
Thank you and Susan -- great presentation. Would love to see more in the future with Fee Schedule changes or updates. — Linda
We want to thank Sue for answering all of our questions promptly. — Gena
Thank you Glen and Sue - Great job - I hope to see more webinars in the future! — Laura
The next Medical Fee Advisory Board Meeting will on December 10th and we are close to providing opinions on most of the major areas of questions/concerns that were brought to our attention during the seminars.
July 17
2009
Medical Fee Schedule in Wisconsin
The Wisconsin Worker's Compensation Advisory Council (WCAC) once again is engaged in its biennial discussions on whether or not Wisconsin needs a medical fee schedule. Healthcare providers in Wisconsin continue to point to nice outcomes within the Workers' Compensation Researchers Institute (WCRI) study states (there are 13 such states). At the same time, WCRI and other studies do show that costs per procedure and overall medical costs per claim seem to be rising at an alarming rate in Wisconsin. Currently, Wisconsin is without a fee schedule and only has the certified database system as a backstop for payment control (free market forces and medical bill review services do appear to have some impact on payment levels). The databases are established at 1.4 standard deviations from the mean which establishes a maximum payment level significantly beyond most known payment levels. These databases only impact extreme outlier charges which allows for the extremely high payments in Wisconsin. If we look at surrounding states and their workers compensation medical payments, on average, we see significantly lower payment rates. Traditionally, the WCAC has become bogged down on this issue and has been unable to reach an agreement on a fee schedule that resembles something we see in many other states. True Course managed a major data call for Wisconsin Insurance Alliance (WIA) which is intended to provide a baseline analysis from which fee schedule designs and payment levels can be intelligently discussed. The study results and conclusions will be released at the discretion of the WIA. Medical fee schedules are detailed and complex instruments subject to surrounding rules and frequent changes in procedure coding. Even if the WCAC can reach an agreement on the necessity of a medical fee schedule, the large task of publishing a comprehensive fee schedule and supporting rules will still lie ahead.
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