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WCRI- live – Illinois Fee Schedule Caused 30% Reduction in Medical Costs


Illinois Fee Schedule Reduction Causes Changes

The Illinois fee schedule reduction of 30% – blogging –  WCRI live.

30% across the board reduction by Illinois and its effects

As with most across the board cuts in WC in other states over time, the costs per claim were not reduced in total by 30%.   I am not a fan of synthetic fee schedules.   A synthetic fee schedule is one that does not follow the usual fee schedule structure as is most other states.

Major surgery fees were not reduced.  Illinois was the third-highest state in major surgical fees post-fee schedule reduction.

Graphic of 30 % Illinois Fee Schedule Reduction
(c) 123RF

Fees for office visits, physical medicine, and pain management injections were reduced the most (25%, 27%, and 26% respectively.)

Reasons for less than 30% reduction

  • Network penetration and resulting discounts
  • Negotiated prices were not to the 30% level
  • More complex office visits than before the reduction

I think Illinois had the right idea, but as I have presented in a few articles, a straight synthetic fee schedule is not the best approach.   However, kudos to Illinois for trending down overall costs regardless of not reducing costs by 30%.   It is a start that can be adapted in the future- possibly with some of the reduction elements in Texas or other states.

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One Response

  1. I am a board certified pain specialist with 25 years of experience and 14 years of post-graduate eduction. W/C companies in Illinois are now reimbursing me for office visits at a rate that is equivalent to $120 per hour. Considering that we pay about $25 per patient in malpractice payments alone and see about 2 patients per hour, do you think that this is a reasonable fee??


James J Moore - Workers Comp Expert

Raleigh, NC, United States

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James founded a Workers’ Compensation consulting firm, J&L Risk Management Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

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James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

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