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...

2012 IWCC & IDOI updates

There have been several IWCC & IDOI updates since our last post.

Governor Quinn announced the appointment of Andrew Boron as the new director of the Illinois Department of Insurance.

Governor Quinn also announced the appointments of three additional IWCC arbitrators:

• William Gallagher will handle former Arb. Tobin's call in Zone 2 (Quincy, Springfield, and Urbana).
• Douglas McCarthy will be based in Chicago and will serve at large where needed.
• Brandon Zanotti will handle the Chicago "TBA" call formerly handled by Arb. Dollison.

The IWCC announced yesterday that, due to arbitrator and commissioner confirmation hearings, arbitration will be limited this Friday, February 17, 2012.

On Friday, February 17, arbitrators and commissioners will appear before the Senate Executive Appointments Committee in Chicago for their confirmation hearings. Click here for more information on the hearings.  

In Chicago, arbitrators will conduct business from 8:30 - 10:30. At 10:30, Chicago arbitrators will stop business for the day with one exception: Arbitrator Thompson-Smith's 2:00 status call will be held.  

In Waukegan, Arbitrator Holland will handle pro se cases from 8:00 - 9:00 am. He will hold his status call from 9:00 - 10:00 am. At 10:00, he will leave for Chicago.  

All other downstate calls are cancelled for February 17. If your case is set for trial that day, please contact the arbitrator and the other party to reschedule.

Approved Workers' Comp Preferred Provider Programs (PPPs)

The Illinois Department of Insurance updated its Approved Workers' Compensation Preferred Provider Program Administrator List on its website.

HFN, Inc. as now listed as an approved Workers' Compensation Preferred Provider Program Administrator.

IWCC Releases 2012 Fee Schedules

The IWCC stated at the December Medical Fee Advisory Board meeting that the Year 2012 rates would not be available until 12/31/11, but both the new rates and data specifications for downloading the rates are now available on the IWCC's website.

The IWCC updated the medical fee schedule lookup with the new 2012 hospital and non-hospital fee schedule regions.  Since the current and previous years' fee schedules are based on the geozip regions, they are still available under the Archived Fee Schedules 2006 through 2011 tab on the main screen.

Current fee schedule lookup



New fee schedule lookup

Both the IWCC's Rules and Instructions and Guidelines for treatment on or after 9/1/11 are still in process and not available at this time.  A draft version was presented at the December Medical Fee Advisory Board meeting, and at that time, the Secretary of the Commission, Kimberly Janas, requested comments on the draft version.

Arbitrator and 1/1/2012 Fee Schedule Updates

2012 Fee Schedule Region Update
The new IWCC fee schedule regions, and their recalculated fee schedule amounts, become effective on 1/1/2012.  The regions are moving from geozip-based to region/county-based. Per the IWCC Medical Fee Advisory Board's December meeting, the new fee schedule reprice amounts and finalized medical fee schedule lookup will not be publicly available until Saturday, 12/31/2011.

We are currently attempting to confirm the exact data file layout format, and if there will be any sort of geozip to region crosswalk, with Glen Boyle and the IWCC. 

Arbitrator Jutila's case reassignments
The IWCC updated its case reassignment schedule for January 2012.

Effective January 1, 2012, Arbitrator Jutila's cases will be reassigned among the three Region 6 arbitrators: Arbitrators Fratianni, Kinnaman, and O'Malley. Accordingly, the January call, scheduled for Dec. 29, has been cancelled. Corrected notices will be sent.

Send settlement contracts to either of the current Chicago arbitrators (in January, Arbitrator Fratianni or O'Malley). Arb. Williams will still hear Jutila cases during his December trial cycle.

Arbitrator Jutila Passed Away

The IWCC announced the passing of Arbitrator Jerry Jutila on Thursday:

We are sorry to announce that Arbitrator Jerry Jutila passed away today. Jerry joined the Commission as an arbitrator in 2004, served as acting chairman in 2008, then returned to his arbitrator position. He was widely respected as an intelligent, thoughtful, and fair person.

While he struggled with his illness, he worked on a document, "Lessons Learned on the Eighth Floor," intended to help train the new arbitrators. It was just distributed to arbitrators this past week.

Full of practical advice, writing tips, humor, and gentle guidance ("Listen to the other side." "We are public servants and have a duty to be helpful."), he told arbitrators, "At the end of the day, you are going to derive a great deal of satisfaction" from helping people resolve conflicts. The document is a fitting reflection of Jerry's character.

Before coming to the Commission, Jerry represented injured workers for decades, at the firms May, Decker and Associates; Collins, Jutila and Shovlain; and Gibson and Kopsick.

He was a Life Fellow of the Illinois State Bar Association since 1996 and was a member of numerous professional law associations.

Jerry was honorably discharged from the U.S. Air Force Security Service, where he served as Staff Sergeant and Intelligence Analyst.

Our sympathies go to Jerry's wife, Barb, and their extended circle. His passing is an enormous loss.

IWCC December Updates

The IWCC's Medical Fee Advisory Board meeting is scheduled for Wednesday, December 7 at 2pm.  Currently, the only identified topic of discussion on the agenda is a status update on the changes to the medical fee schedule. 

We did send an inquiry to Glen Boyle regarding the posting of the new fee schedule regions' rates on the IWCC website.  Per his response, the anticipated release timeframe should be the end of this week.  We will verify this is still the release schedule at the Board meeting on Wednesday.

IWCC issues impairment ratings to the arbitrators
The Commission voted to provide recommendations to its arbitrators regarding the use of the American Medical Association impairment ratings in the determination of permanent partial disability awards.

Section 8.1b of HB 1698/Public Act 097-0018 included the following language:

...The most current edition of the American Medical Association's "Guides to the Evaluation of Permanent Impairment" shall be used by the physician in determining the level of impairment.

The Commission issued a memo to arbitrators regarding the use of the AMA impairment ratings. It includes the following guidance:

1. An impairment report is not required to be submitted by the parties with a settlement contract. 
2. If an impairment rating is not entered into evidence, the Arbitrator is not precluded from entering a finding of disability.