Updated IWCC Instructions and Guidelines

The IWCC's proposed updates to its Instructions and Guidelines, which incorporate HB 1698's modifications and changes, are now available online.

The IWCC posted its Notice of Proposed Amendments to Sections 7110.5-7110.90 of 50 Ill. Adm. Code 7110 in the March 2 edition of JCAR's (the General Assembly's Joint Committee on Administrative Rules) Illinois Register. The IWCC's notice begins on page 3164.

The updates modify the language of the various sections to reflect the current IWCC state fee schedule guidelines. Some of the major updates:

• The 30% fee schedule reduction effective 9/1/2011
• The new fee schedule regions effective 1/1/2012
• Out-of-state medical provider reimbursement methodology changes effective 6/28/2011
• Implant reimbursement effective 9/1/2011
• 25% above the net manufacturer's invoice price less rebates, plus actual reasonable and customary shipping charges
• The addition of Accredited Ambulatory Surgical Treatment Facilities (ASTFs) to the Ambulatory Surgical Treatment Center (ASTC) pricing guidelines
• ASTFs are defined as those facilities accredited by one of the following organizations:
• American Association for the Accreditation of Ambulatory Surgical Facilities (AAAASF)
• The Joint Commission (formerly JCAHO)
• Accreditation Association for Ambulatory Health Care (AAAHC)
• Until the Commission posts a fee schedule for dental bills, all dental bills are paid following the current methodology
• Prior to 9/1/2011, 76% of actual charge unless billed under the HCPCS Level II schedule or professional fee schedule
• Effective 9/1/2011, 53.2% of actual charge unless billed under the HCPCS Level II schedule or professional fee schedule (incorporates the 30% fee schedule reduction)
• An update to the Cost Outlier trigger effective 9/1/2011.
• Before 9/1/2011, the definition of a cost outlier remains

...extraordinary treatment in which the bill for an inpatient stay is at least two times the fee schedule amount for the assigned DRG after pass-through revenue code charges referred to in subsection (h)(6)(F) have been deducted...

• Effective 9/1/2011, the definition is updated to read

...extraordinary treatment in which the bill for an inpatient stay is at least 2.857 times the fee schedule amount for the assigned DRG after pass-through revenue code charges referred to in subsection (h)(6)(F) have been deducted...