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Permanent link  If you provide care to a workers compensation patient


Susan Piha, manager of research and education for the Illinois Workers' Compensation Commission, asked CDS to share the following news release with members.

The commission has an exhaustive FAQ that should help answer questions. For more information on the fee schedule, follow the links on the commission's home page. Otherwise, call the commission at (312) 814-6611 for more information.

By law, all medical treatment provided to a workers' compensation claimant on or after February 1, 2006 is subject to a fee schedule. A provider is still free to contract with payors for different payment terms but, in the absence of a contract, the provider will be paid according to fee schedule.

By law, a fee for each procedure was calculated for each three-digit zip code in Illinois....

When the IWCC lacked sufficient data to calculate a fee, the law provides that such bills shall be paid at 76% of the charged amount. Dental services that are billed with ADA codes, for example, are paid at 76%. Services that are billed with CPT or HCPCS codes may have fees. Refer to the online fee schedule.

The fee schedule amount is considered full payment. Providers may not seek to obtain the difference between the charged amount and the fee schedule amount from the injured worker or the employer. Balance billing for workers' compensation claims is now illegal pursuant to 820 ILCS 305/8.2(e).

The law also provides that the payor shall pay the medical provider within 60 days of the date the payor receives a bill that contains substantially all the required data elements necessary to adjudicate the bill. The provider may charge interest of 1% per month. If you cannot resolve disputes regarding payment with the payor, you should ask the patient/injured worker to request a hearing before an IWCC arbitrator regarding unpaid medical bills.

The Illinois Workers' Compensation Commission operates the court system that resolves disputes regarding workers' compensation. It does not pay the benefits. In most cases, insurance companies pay benefits on the employers' behalf.


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