A new study from the Workers Compensation Research Institute (WCRI) compares the workers comp fee schedule rates and Medicare rates for a variety of medical services in Illinois as of 2015.
The medical services covered in the report, Evaluation of the 2015 Fee Schedule Rates in Illinois, are professional medical services, hospital outpatient and ambulatory surgery center (ASC) facility services related to surgical procedures, and hospital inpatient services. The analysis focused on the common services delivered to injured workers within each category.
Additionally, to provide some context on where Illinois stands with respect to other states, the study compared the fee schedules in Illinois relative to Medicare (as of 2015) with fee schedule rates relative to Medicare in other states (as of 2011) for professional medical services. The study computed the workers’ compensation fee schedule rate as a percentage above or below the Medicare rate.
The following are among the study’s findings:
- In 2015, the workers comp fee schedule rates for professional services in Illinois were on average 69 percent above the 2015 Medicare rates for the same set of services in the state.
- As compared with July 2011, Illinois moved down in the interstate ranking for overall professional prices in 2015 but remained among the states with relatively higher workers comp fee schedule rates relative to Medicare.
- The difference between workers comp fee schedule rates and Medicare rates varied tremendously across seven groups of professional services in Illinois, ranging from near Medicare for evaluation and management services to 339 percent above Medicare rates for major surgery.
- In 2015, the Illinois fee schedule rates for the hospital outpatient facility services associated with common knee and shoulder surgeries were on average 157 percent and 110 percent higher than Medicare rates for similar knee and shoulder surgeries, respectively.
- At the procedure level, the difference in workers comp fee schedule rates over Medicare rates for common surgeries performed at ASC settings varied substantially, from $2,368 to as much as $5,282.
In 2015, for hospital inpatient stays associated with common inpatient procedures, Illinois set fee schedule rates 54 percent to 119 percent above Medicare.
For more information about this study, or to purchase it, visit http://www.wcrinet.org/result/eval_2015_IL_FS_result.html.
Author Kori Shafer-Stack, Editor, Amaxx Risk Solutions, Inc. is an expert in post-injury response procedures and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. www.reduceyourworkerscomp.com. Contact: [email protected].
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