Workers Compensation Fee Schedule

Workers Compensation Fee Schedule

The original Workers Compensation Medical Fee Schedule was adopted in 2005 when the Illinois Workers’ Compensation was reformed and signed into law by Governor Blagojevich. This allowed the state to set medical fees established at 90% of the 80th percentile as per Ingenix and Midwest Work Comp Review.

History

 Prior to 2005, there was not a workers compensation fee schedule in Illinois, and fees submitted for services rendered were increasing at an annual rate of double digits, and basically became a runaway train. As a result of this medical inflation, the State of Illinois developed the WC Medical Fee Schedule to slow the rapidly increasing costs. With this in place, Illinois businesses and the State of Illinois expected immediate cost savings. This cost-containment measure occurred statewide with ongoing savings for Illinois employers trying to protect jobs in Illinois. These fees were established by geographical location according to the provider’s geozip (first three digits of the zip code).

Even after these changes took effect, the State of Illinois still ranked #1 in fees as compared to 16 states, as noted by the Work Comp Research Institute (WCRI). Employers continued an onslaught of complaints to legislators and indicated this WC Medical Fee Schedule was not actually producing medical cost savings. As WC medical costs continued to increase, so had the WC insurance premiums, and industry just could not support that anymore.

2011 Update

Late 2011, State of Illinois went through another reform in Workers’ Compensation as signed by Governor Quinn. Besides other significant changes, the change that would affect medical providers the most would be the NEW WC Medical Fee Schedule, and the WC Medical fee schedules were slashed 30%.

Many doctors have contacted the ICS and me regarding the reduction of fees. Some have only seen a 25% reduction, but in Chicago, fees were approximately 40% lower. The DCs argument was that this was much greater than what the Act indicated, which was a 30% reduction…

Regions

With the new Illinois WC Act, the geographically 29 geozips was collapsed to a 4 area system. This became less confusing with fewer fee-schedules to deal with. The new 4 regions were defined by groups of counties and not geozips and are:

  • Cook County
  • DuPage, Kane, Lake, & Will Counties
  • Bond, Calhoun, Clinton, Jersey, Macoupin, Madison, Monroe, Montgomery, Randolph, St. Clair, & Washington Counties.
  • All other counties in the state.

There were medical providers that saw a dramatic decrease in their fees, i.e., Chicago. And, there were medical providers that saw only a moderate change in their fees, i.e., Central Illinois.

Although the state considered a variety of methods for determining averages for the new regions, they chose the route of utilizing the straight average rather than the weighted average of that region.

The 2011 fees were collapsed and averaged, and then the Consumer Price Index (CPI) for 2012 was added onto it. As a result, although a 30% reduction was to occur, certain areas, such as Cook County, had a straight average for the populated area of Cook County causing a larger decrease in the WC Medical Fee Schedule for Region 1 compared to the surrounding suburbs. Just as in Central Illinois, a small town that had low WC Medical Fee Schedule actually saw a dramatic increase in their fees. All in the attempt to reduce the excess of medical fees in Illinois.

Conclusion

Was this enough to quiet the critics on stopping the runaway train of workers compensation premiums? Only time will tell.

About the Author: Dr. Boileve is a Certified Medical Compliance Specialist, as well as a candidate for Certified Insurance Consultant/Reviewer (Logan University). He represents chiropractic on the medical advisory board of the Work Comp Research Institute (WCRI for the State of Illinois.

Fee Schedule Rates

The medical fee schedule rates are online at https://iwcc.optum.com/download.asp

About Author

Carlos Boileve, DC, MCS-P

After completing his schooling in Chicago, Dr. Boileve entered the National College of Chiropractic (NCC) now the National University of Health Sciences (NUHS) in 1976, graduating in 1980, and licensed in Illinois as a Chiropractic Physician.He is a Certified Medical Compliance Specialist, and on the Medical Advisory Board of the Workers' Compensation Research Institute (WCRI). Dr. Boileve is also is a Certified Insurance Consultant /Reviewer and has been on staff at the National College of Naprapathic Medicine since 2007 as an instructor in Histology, Anatomy, Embryology, Physiology, and Symptomology and Lab Interpretation.

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