HEALTH SYSTEMS INTERNATIONAL EXPANDS EXCLUSIVE OFFERINGS THROUGH ACQUISITION OF TRUE COURSE
Indianapolis, Indiana. – April 6, 2011. Health Systems International today announced the acquisition of True Course Medical Data Analysis & Claims Services, LLC. True Course, based in Milwaukee, Wisconsin, is a data informatics and claims services company. It provides high quality medical data analysis and supportive claim services in Illinois and Wisconsin. True Course is at the forefront of workers' compensation medical fee schedule development and offers the most comprehensive set of certified databases in Wisconsin. The acquisition further expands the exclusive technology and business offerings of Health Systems International. Read More
The Compass…Glen's blog on the state of the industry
Oct 28
2010
IWCC Withdraws Emergency Rule
The Illinois Worker's Compensation Commission has decided to withdraw the emergency rule that relates to implants and surgical facilities not licensed by IDPH. There is paperwork that needs to be filed with JCAR and it is expected that it will be filed on Thursday, October 28th. The withdrawal will become effective upon filing.
There have been a number of technical/legal questions and a wave of political energy opposing the implant and surgical facility emergency rules, and the rules acceptance by JCAR was unlikely. The withdrawal does not have retroactive impact but will be effective upon the date of filing.
The IWCC will put the notice of repeal on line on the date it is effective. Feel free to contact Glen at True Course should you have any further questions.
Sept 28
2010
Workers' Compensation Centennial Commission
Wisconsin Gov. Francis E. McGovern (1911-15) signed the first constitutional workers' compensation law on May 3, 1911. To commemorate the 100th anniversary of the issuance of the first insurance policy under the nation’s first constitutional workers compensation law, the Workers’ Compensation Centennial Commission was formed. The official recognition will be September 1, 2011. The full history of workers’ compensation encompasses many milestones both before and after the historic 1911 event, and we strongly encourage you to visit www.workerscomp100.org. This site contains historic pictures, a summary of key dates, and a recently-compiled history of workers’ compensation by our much respected friend Greg Krohm, PhD, executive director of the International Association of Industrial Accident Boards and Commissions. Enjoy!
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.
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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