IWCC Medical Fee Schedule Re-Posted

As of this morning, the Illinois Workers' Compensation Commission's website has the 2013 Medical Fee Schedule re-posted on its fee schedule page.  The following link will take you the website lookup (choose Treatment Year 2013 for the new rates): Medical Fee Schedule/FAQ  

The original link was retracted by the IWCC contractor, Optuminsight, due to data integrity issues. 

Unless there are any further announcements from the IWCC, the 2013 fee schedule is effective January 1, 2013.

2013 Medical Fee Schedule: Status Update

As announced previously at its December Medical Fee Advisory Board meeting, the IWCC posted the 2013 medical fee schedule on its website; however, it pulled the schedule shortly after due to issues identified by the vendor.

The IWCC announcement:

The 2013 fee schedule was posted, but some problems were identified, and the vendor, Optuminsight, took it down to work on it. Optuminsight is working on adding code descriptions and posting the correct surgical codes to the Hospital Outpatient and ASTC fee schedules, so please view the schedule with caution. We will announce when this work has been completed.  

In the meantime, if you identify any issues with the 2013 schedule, please let us know.

The 2013 medical fee schedule is effective on January 1, 2013.  We will post additional updates when the IWCC website rereleases the schedule or Optuminsight announces any additional changes.

New IWCC Arbitration and Commission Review Board Rules

The December 21 edition of the Illinois Register includes two adopted amendment rulemakings from the Illinois Workers' Compensation Commission.  Both rulemakings, effective December 4, deal with complaints and review procedures of IWCC Arbitrators and Commissioners.
 
The IWCC put out an announcement regarding these two updated rules, and included in that announcement was a new form to submit complaints to the Commission Review Board:  IWCC Commission Review Board Complaint Form

New/Update Rules Overview

Arbitration (PDF document page 285)

• 50 Ill Adm Code 7030
• Proposed 8/17/2012
• Effective 12/4/2012 

Differences between Proposal and Final Version: In subsections (f)(1)(B) and (f)(2)(B),  the Final Version specifies that the assignment of a petition to disqualify either an  Arbitrator or Commissioner shall be made randomly by the Commission. The Final Version adds a new subsection (f)(3), which specifies that a petition for substitution may be made to the Commission if reasonable notice of the application has been given to the adverse party or his or her attorney.

Summary and Purpose of Rulemaking: The amendment addresses an audit finding set forth by Auditor General William Holland in the audit directed pursuant to House Resolution 131 of the 97th General Assembly. Specifically, the audit found that the current version of Section 7030.30 conflicts with the changes of Public Act 97-18. Public Act 97-18 provided that the Canons of Judicial Conduct as adopted by the Illinois Supreme Court apply to the hearing and non-hearing conduct of the Arbitrators and Commissioner. Thus, these changes to Section 7030.30 align the bases for disqualification and also the remittal of a disqualification by and Arbitrator or Commissioner with the provisions of Canon 3 of the Canons of Judicial Conduct.  

In addition, the amendment creates a formalized process for the filing of a Petition for Substitution of an Arbitrator or Commissioner. There is one published Appellate Court opinion that calls on the Commission to promulgate such a rule, Preston v. Industrial Comm'n, 332 Ill. App. 3d 708 (3rd Dist. 2002). In that case, a Commissioner who was subject to a petition to disqualify sat on the panel that ruled on the petition. While the majority found no error in the hearing process, the Court recommended that the Commission promulgate a rule to address the procedural handling of petitions to disqualify Commissioners.

 

From everyone here at the IL Workers' Comp Reform Guide & HFN, Inc... 

Merry Christmas and Happy Holidays

 

2012 NCCI IL Statutory Data Report & Advisory Rates

A couple of additional Illinois Department of Insurance updates...

The IDOI recently posted NCCI's 2012 Rating Organization Statutory Data Submission on its website.  NCCI is required by the Illinois Insurance Code to submit the following information annually: 

1. Indemnity and medical paid and paid+case losses for each of the past 10 years, by policy year
2. Medical payments for each of the past 10 years, by policy year
3. Indemnity claim Information including cumulative paid+case losses, by policy year by calendar year of development. This includes losses and frequency of claims in medical only, permanent partial disability, permanent total disability, temporary total disability and fatalities 
4. Frequency and severity by injury type
5. Aggregate (indemnity+medical) paid+case losses, and claim count by class of employee

The IDOI also confirmed that it had completed its review and filed NCCI's proposed 3.8% reduction for the WC Advisory and Lost Cost rates effective 2013 (see our previous overview of the filing & the IDOI's August press release announcing the rate review).

Department of Insurance Payment Compliance Bulletin

The Illinois Department of Insurance released a compliance bulletin reminder to all companies licensed/approved to provide workers' compensation coverage in Illinois.  The bulletin covers provider notification and payment requirements included in Sections 8.2(d)(2) & (3) of HB 1698/PA 97-18.

Section 8.2(d)(2) 

If the claim does not contain substantially all the required data elements necessary to adjudicate the bill, or the claim is denied for any other reason, in whole or in part, the employer or insurer shall provide written notification, explaining the basis for the denial and describing any additional necessary data elements, to the provider within 30 days of receipt of the bill.

 

Section 8.2(d)(3) 

In the case of nonpayment to a provider within 30 days of receipt of the bill which contained substantially all of the required data elements necessary to adjudicate the bill or nonpayment to a provider of a portion of such a bill up to the lesser of the actual charge or the payment level set by the Commission in the fee schedule established in this Section, the bill, or portion of the bill, shall incur interest at a rate of 1% per month payable to the provider. Any required interest payment shall be made within 30 days after payment.
 

The Illinois Workers' Compensation Commission also released a notice regarding this IDOI bulletin. 

IWCC Ottawa Trial Date Cancellation

The Illinois Workers' Compensation Commission announced a change to its Ottawa, IL arbitration schedule.  The 12/28/2012 trial date (located at the LaSalle County Courthouse, 119 W. Madison Street, Ottawa, IL) is cancelled due to a scheduling conflict.

Due to a scheduling conflict, we have eliminated the last day of the December call in Ottawa. Arbitrator Falcioni will conduct the call as scheduled on Dec. 24, and trials will be conducted on Dec. 26 and 27. He will not appear on Dec. 28. We apologize for any inconvenience.