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  • Access the AMA’s Guides on Disability Impairment for Workers’ Comp Reporting

    Learn more with ISMS’ webinar!

    The Illinois Workers' Compensation Act states that physicians preparing a permanent partial disability impairment report shall use “the most current edition” of the AMA’s guides in determining the level of impairment. The American Medical Association (AMA) supports the use of the most current medicine to perform fair and consistent permanent impairment evaluations and recently published the latest edition of its AMA Guides to the Evaluation of Permanent Impairment, 6th Edition. This edition is considered the most current version as of July 1, 2021.  

    Resources:

      Questions? Please contact the ISMS Health Policy Research and Advocacy team by email



  • Part 3: How Does the Prior Authorization Reform Act Address Adverse Determinations?

    During the Spring Legislative Session in Springfield, the General Assembly unanimously approved the Prior Authorization Reform Act (House Bill 711), which has been sent to Governor Pritzker! This top ISMS initiative requires that substantive and important changes be made to insurer prior authorization (PA) practices.

    Physician Advocate is taking a deep dive into the various components of this important legislation. This week’s focus is adverse determinations.


    Part 3: How Does the Prior Authorization Reform Act Address Adverse Determinations?

     

    The current problem: Prior authorization denials – or “adverse determinations” – are often made by non-physicians or physicians in different specialty areas who have little or no experience treating the condition for which the prior authorization request is being made. Such reviewers lack the specialized knowledge necessary to appropriately evaluate a prior authorization request.

     

    How House Bill 711 helps: It establishes minimum qualifications for individuals who can deny a prior authorization request, and specifies the information that a utilization review organization must provide at the time of denial, which helps the physician understand what additional information may be needed to support an approval for the service.

     Read more …


  • ISMS Fights Against Establishing Harmful New Medical Liability Precedent!

    IL Supreme Court must strike down flawed ruling pertaining to jury instructions

    ISMS recently partnered with the Litigation Center of the American Medical Association in submitting an amicus brief on a case currently pending before the Illinois Supreme Court. In the case, a jury found that four physicians and a hospital were not negligent in their care of a woman who came into the emergency department for treatment, left the hospital against the recommendations of the healthcare professionals, and later passed away. 

    During the trial, the trial judge denied the plaintiff’s requests for the jury to consider instructions on:

    1. Whether there was “lost chance” at a better medical outcome, which would allow the patient to ask for compensation if alleged medical negligence diminished the chance of survival.

    2. Informed consent as applied to the patient’s discharge, which would allow jurors to consider whether the patient was given enough information about what would happen if she went home rather than remain at the hospital. 

    The estate of the woman appealed, and the First District Appellate Court declined to follow longstanding Illinois precedent and reversed the trial court, ruling that the plaintiff should be given a new trial so that the jury can be given the two instructions to consider. The defendants appealed to the Illinois Supreme Court.

    Should the Illinois Supreme Court uphold the decision of the First District Appellate Court, it could have a chilling effect on the ability of Illinois physicians to effectively defend themselves at trial because it will result in lower legal standards for medical negligence claims, and will encourage speculative litigation when a patient succumbs to a disease. Patients and physicians must be able to rely on Illinois courts to follow precedent and sound legal principles, including in difficult cases such as this one.

    ISMS is watching this case closely and will report on any developments in future editions of Physician Advocate. Stay tuned! 

    If you have questions, please contact the ISMS Legal Division by email



  • President Touts ISMS Legislative Wins During Chicago Radio Interview

    During a lively half-hour radio interview, ISMS President Regan Thomas, MD, highlighted the major ISMS-backed legislative victories accomplished during the most recent session of the Illinois General Assembly. 

    As a guest on the At Issue public affairs program on WBBM radio, Dr. Thomas talked about ISMS’ successful initiative to reform prior authorization requests and parity for telehealth insurance payments. He also reminded listeners to visit their doctors to catch-up on routine care that may have been missed during the pandemic and urged everyone to get the COVID-19 vaccination. 

    Listen to Dr. Thomas’ interview!

    If you have questions, please contact us



  • Does Your Staff Receive “Off the Charts”? Know About Free Support from ISMS?

    Practice management professionals balance a multitude of tasks, and are bound to have questions or need guidance.

    That’s where we come in. All of your team members working with ISMS members have access to numerous resources, including our quarterly newsletter, Off the Charts – designed specifically for them. 

    Sign up your staff to receive the newsletter and request web account access for them so they can view members’ only content!

    If you or anyone on your team has questions, contact the ISMS Division of Member Advocacy by email



  • Spending Too Much Time on Credentialing Paperwork?

    If you are buried in time-consuming credentialing tasks, here’s how you can streamline the process! ISMS offers members Credentialing and Enrollment Services, powered by 3WON. 

    This credentials verification service, a partnership between ISMS and 3WON, can help you simplify and automate the time-consuming credentialing process. 

    Here’s how it works: 3WON assumes the responsibility of credentialing and enrollment for physicians by collecting the data once, maintaining its accuracy, and distributing it to authorized parties – reducing the time you and your staff members spend on credentialing. 

    This ISMS Benefit Partner is a cloud-based product so there's no need for a software purchase. Therefore, there are no implementation or maintenance fees.

    For ISMS members, 3WON's fees are locked at the same level for the first three years! 

    Contact ISMS Credentialing and Enrollment Services, Powered by 3WON today!

    Check out other ISMS Benefit Partners




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