Evaluating Fee Schedule Rates In Illinois As Of 2015

Share Article

This new WCRI study compares the fee schedule rates and Medicare rates for a variety of medical services in Illinois as of 2015. The medical services covered in the report 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 most common services delivered to injured workers within each category.

Picture of the state of Illinois.
In 2015, the workers’ compensation 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.

A new study from the Workers Compensation Research Institute (WCRI) 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 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’ compensation 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’ compensation fee schedule rates relative to Medicare.
  •     The difference between workers’ compensation 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’ compensation 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.

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 & Medicaid 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.

For more information about this study or to purchase it, visit http://www.wcrinet.org/result/eval_2015_IL_FS_result.html.

ABOUT WCRI:

The Workers Compensation Research Institute (WCRI) is an independent, not-for-profit research organization based in Cambridge, MA. Organized in late 1983, the Institute does not take positions on the issues it researches; rather, it provides information obtained through studies and data collection efforts, which conform to recognized scientific methods. Objectivity is further ensured through rigorous, unbiased peer review procedures. WCRI's diverse membership includes employers; insurers; governmental entities; managed care companies; health care providers; insurance regulators; state labor organizations; and state administrative agencies in the U.S., Canada, Australia and New Zealand.

Share article on social media or email:

View article via:

Pdf Print

Contact Author

Andrew Kenneally
Workers Compensation Research Institute
+1 (617) 661-9274 Ext: 257
Email >
Workers Compensation Research Institute - WCRI
since: 06/2011
Like >
WCRI

Follow us on
Visit website