Evaluation of the 2015 Fee Schedule Rates in Illinois

By Olesya Fomenko

February 1, 2016 Related Topics: Fee Schedules

This study compares the workers' compensation fee schedule rates and Medicare rates for a variety of medical services in Illinois as of 2015.The medical services covered in the analysis are professional medical services, hospital outpatient and ambulatory surgery center (ASC) facility services related to  surgical procedures, and hospital inpatient services.  The report focused on the most 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 data for this report come from Illinois' workers' compensation fee schedules for commonly used medical services in workers' compensation and were obtained from the Illinois Workers' Compensation Commission.  Additionally, the 2015 Medicare fee schedules for Illinois were used in the analysis and were obtained from the Centers for Medicare & Medical Services. In the comparisons of fee schedules for professional medical services, the study used workers' compensation fee schedules and Medicare rates for 43 states with workers' compensation professional fee schedules as of July 2011.

Evaluation of the 2015 Fee Schedule Rates in Illinois. Olesya Fomenko.  February 2016. WC-16-20.

 

Copyright: WCRI

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Research Questions:

  1. How does the Illinois workers' compensation fee schedule for professional services compare with the Medicare rates in the state for 2015?
  2. How does the Illinois professional fee schedule relative to Medicare as of 2015 compare with the fee schedule rates in other states as of 2011?
  3. How much above or below Medicare does Illinois set the hospital outpatient fee schedule rates for facility services associated with common knee and shoulder surgeries, overall and for select surgeries?
  4. What percentage above or below Medicare does Illinois set the ASC fee schedule rate for facility services associated with common knee and shoulder surgeries, overall and for select surgeries?
  5. How do the workers' compensation hospital inpatient fee schedule rates for select common diagnostic groups in Illinois compare with the Medicare rates for similar inpatient stays in 2015?

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