Illinois Medical Fee Schedule FAQ and Guidelines 2010

3-3-10

The Illinois Workers Compensation Medical Fee Schedule has been supplemented with answers to FAQs generated from recent fee schedule seminars around the state. As a result of common questions posed by the medical community and workers compensation payers, the Commission issued updated Medical Fee Schedule Instructions and Guidelines ( 1/25/10) for treatment occurring after 2/1/09 and they issued a new list of common Medical Fee Schedule FAQs (1/25/10) that were generated directly out of the seminars.

Naturally, the fee schedule generated a lot of interest from hospitals, treating doctors and the health care providers from the community at large. I share the above links for obtaining updated information that may help workers compensation health care professionals in answering some of their more common questions.

If your representatives were unable to attend the official medical fee schedule seminars, the Medical Fee Schedule Power Point presentation can be found here.

Many answers to medical bill questions were already posted on the Illinois Workers Compensation Commission web site found at “Frequently Asked Medical Questions” . Whenever providers or payers have a medical questions, they are encouraged to check this page first.

These detailed billing questions are often outside the normal knowledge of Illinois workers compensation attorneys as they often relate to very specific billing and payment issues. For example, the updates address correct billing modifiers for bilateral procedures. Not your usual type stuff. While our Chicago workers comp attorneys may not know the answer, we often know where to look or who to ask. As yet another uncommon example, the MS-DRG crosswalk is available online here but the Illinois Workers Comp Fee Schedule incorporates the new MS-DRG hospital inpatient codes for treatment after 6/30/09.

We were just recently asked by a physician at what point can they start charging statutory interest at 1% per month on the unpaid balance of their bills?

That answer is contained in Question # 61 in the updated FAQs. Answer: The medical providers can start charging interest on unpaid amounts after 60 days from the date that the workers compensation payer receives "substantially all of the information necessary to adjudicate the bill".

The exact data elements are not specified in the fee schedule but a workers compensation carrier can certainly argue that interest does not apply if customary billing information is missing. All normal relevant information should be completely filled out on the standardized bill.

The Commission acknowledges that the medical fee schedule guidelines and FAQ cannot address all of the possible questions that might arise in practice but they hope that the parties will continue to use common coding procedures and follow common reimbursement practices to fill in any of the blanks that are not explicitly specified in the guidelines or instructions. You can email your remaining fee schedule questions to feeschdquestions.wcc@illinois.gov

If a dispute continues to exist after reviewing all of the answers provided, the only way for a medical provider to get an official ruling from the Commission is for the employee's attorney or for the employer's attorney to take the issue to trial before an Arbitrator. That arbitration decision can then be subject to an appeal for further review by a panel of the Commissioners who will decide disputed cases for the official ruling of the Commission.

We hope the above links will provide helpful answers our doctors, medical providers and payers while the industry continues to adapt to the new fee schedule changes, requirements and procedures.


Chicago Workers Compensation Attorneys -- 03-02-10

ISBA Advanced Seminar on Illinois Workers Compensation

9-14-08

The ISBA Workers Compensation Section will be hosting a CLE program on Advanced Illinois Workers Compensation on October 13, 2008 offered both in Chicago at the ISBA Regional Office (map and directions) and in Collinsville, Illinois (map and directions). The course will include current topics facing Illinois workers' compensation attorneys, including repetitive trauma in carpal tunnel cases, workplace slip and fall injuries, parking lot cases, qualifications and obligations for vocational rehabilitation and job retraining, Medicare Set Aside future medical expense accounts – avoiding pitfalls, ethical practice considerations at the Illinois Workers Compensation Commission and an update on recent Illinois workers compensation case law.

John B. Adams,moderator, Roddy, Leahy, Guill & Zima, Ltd, Chicago

Speakers:

David Barish, Katz Friedman Eagle et. al., Chicago (Chicago program)
Deborah Benzing, Law Offices of Lauren Meachum, Chicago (Chicago program)
Brad Bleakney, Bleakney and Troiani, Chicago (Chicago program)
Richard Hannigan, Mundelein (Chicago program)
Carol Hartline, Williams and McCarthy, Rockford (Collinsville program)
Jennifer Kieswetter, Ottawa (Chicago program)
Michelle Lafayette, Ganan & Shapiro, PC, Chicago (Collinsville program)
Kevin Meckler, Carbondale (Collinsville program)
David Menchetti, Cullen, Haskins, Nicholson & Menchetti, Chicago (Chicago program)
Robert C. Nelson, Nelson & Nelson, Belleville (Collinsville program)
Bradford Peterson, Urbana (Collinsville program)
Lawrence Scordino, Chicago (Chicago program)
Kristen Wadiak, Beatty and Motil, Glen Carbon (Collinsville program)
Kenneth Werts, Craig & Craig, Mt. Vernon (Collinsville program)

ISBA members $135 in advance and $150 the week of seminar. 5 MCLE credits For online registration

Chicago Workers Compensation Attorneys -- http://wc-chicago.com - 9-14-08

Chicago Workers Compensation Attorneys

8-02-08

Chicago workers compensation attorneys with advanced trial and appeal practice before the Illinois Workers Compensation Commission since 1984. We have successfully tried all types of Illinois work injury claims in construction, food service, hospital, manufacturing and transportation.

Our Chicago workers compensation attorneys have extensive trial experience in Illinois injury claims covering a broad range of medical conditions and injury types. Our experienced attorneys work to maintain a competitive edge in Illinois work injury litigation and workers compensation injury claims.

We attempt to provide each client with individual instruction, preparation, education and available options in Illinois work injury claims. We provide dedicated and aggressive representation in Illinois workers compensation and assistance in work injury litigation in Chicago and the surrounding area cities which include:

Chicago and suburbs, Waukegan, Barrington, Lake Zurich, Mundelein, Libertyville, McHenry, Woodstock, Geneva, St. Charles, Wheaton, Downers Grove, Orland Park, Hinsdale, Naperville, Aurora, Romeoville, Joliet, Bourbonnais and Kankakee.

Covering Cook County, Lake County, McHenry County, Kane County, DuPage County, Will and Kankakee County.

If in need of assistance, contact our office at (312) 541-0049 for a review, meeting or claim consultation.


Chicago Workers Compensation Attorneys -- http://wc-chicago.com 8-02-08