IWCC posts solid Medical Fee Schedule seminar questions-and-answers. We add comments from one of our knowledgeable readers in that part of the WC industry.
Editor’s comment: Glen Boyle, Medical Fee Schedule project manager, held seven seminars around the state and one statewide webinar to explain the Illinois Medical Fee Schedule to payers and providers of workers’ compensation medical treatment. The Commission announced their appreciation to the industry for all the questions raised and the exchanges between payers and providers that occurred during the seminars and webinar.
The discussions prompted the Commission to issue guidelines on the three issues that came up the most. They also made a correction to their Instructions and Guidelines.
To read the new guidelines, and the questions and answers from the seminars, go to
http://www.iwcc.il.gov/fsq.pdf
We admit we aren’t Medical Fee Schedule specialists. Comments from one of our readers who is a specialist:
I especially liked the part that said to pay CRNAs at physician rates and to, how did they put it? “translate?” whether –AS represents a modifier -80 or a modifier -81.
I also liked their recommendation to just pay 100% to the physician anesthesiologist and let him/her and the facility hash out who pays the CRNA is going to be interesting in practice…
Since they have instructed us to pay ASTC’s at 76% of billed (except carve outs at 65%) if even one of the procedures falls into the POC76 category, it would have been particularly nice for them to have mentioned paying the subsequent/secondary procedures at 50% of 76% which would be reasonable in view of all other multiple procedure rules.
And after all this time they are still just “recommend[ing] reexamining the implant rule. Policy change is difficult and can take some time,” they said.
Other than these points, everything else makes sense in view of existing law, and it is obvious they really tried to be reasonable and direct in clarifying facility reimbursement problem areas. I do applaud their efforts. Communication has at least been established, and that is a very good thing.
We thank MP for her input and permission to publish her thoughts for your consideration.
