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June 2014
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  • Breaking News: ISMS Successful in Obtaining Increased Reimbursement for Illinois Workers Comp

    9.5 percent average increase based on new rates

    On July 16, 2014, the Illinois Workers' Compensation Commission (IWCC) voted unanimously to raise reimbursement rates for non-surgical evaluation and management (E/M) CPT codes on the Workers' Compensation Fee Schedule. 

    The increases vary by CPT code and the geographic location of the service provided, but fees are expected to increase, on average, by 9.5 percent, based on the new rates for commonly performed outpatient office visits. These fee increases are effective immediately, and the IWCC is in the process of updating the fee schedule and notifying WC insurers of this policy change.

    This action comes in response to sustained advocacy by the ISMS, the Illinois Society of Anesthesiologists and many of our individual members, and is an acknowledgement by the Commission that low reimbursement rates for non-surgical evaluation and management services have significantly deterred physician participation in the workers' compensation program.

    The Workers' Compensation Act authorizes the Commission to increase fee schedule amounts when it finds there is a significant limitation on injured workers' access to medical care; the ISMS and individual physicians successfully demonstrated that low fees for E/M services - the lowest in the nation by some estimates - seriously hindered patient access to needed care.

    At press time, ISMS has not yet completed updates to our webpage on this important issue.  Check back during the week of July 21 for links to the updated WC fee schedule, and examples of ISMS and individual physician advocacy with the Commission.

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