During the August 23 meeting, the Board narrowed the potential calculation methodologies down to two options:
- A straight average of all the included geozips' reprice amounts for each code
- A weighted average, by geozip population, of all the included geozips' reprice amounts for each code
There was a great deal of debate over legislative intent in regard to whether the calculations for the new regions' fee schedule amounts had to maintain the 30% rate reduction that took effect on 9/1/2011. By collapsing geozips into new regions and averaging the different geozip fee schedule amounts, some providers will see additional reductions to their current fee schedule base rates, while others in the same region will see their base rates increase.
Two examples from Tuesday's Board meeting:
- New Non-Hospital Region 1 (Cook County)
- CPT Code 99213 (Office visit for the evaluation and management of an established patient)
- New Hospital Region 14 (All Other Counties)
- DRG 460 (Spinal Fusion except Cervical w/o MCC)
After a great deal of debate, a majority of the Board voted to utilize a weighted average, by geozip population, of all the included geozips' reprice amounts for each code.
Glen Boyle & his team will utilize this weighted average methodology to calculate the new fee schedule base rates for the 14 Hospital and 4 Non-Hospital fee schedule regions effective 1/1/2012. It appears everyone who currently applies the state fee schedule to workers' comp bills will also have to update their systems as the fee schedule migrates from geozip-based schedules to county/region-based schedules.