IL Medicare Reimbursement Rates 69% Higher on Average

Posted By: Production
February 15, 2016 @ 9:59 am
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When compared to Medicare rates, Illinois’ reimbursement rates for workers’ compensation claims are higher for most categories than most fee schedule states. That’s according to the latest report from the Workers’ Compensation Research Institute on Illinois’ workers’ compensation system.

Olesya Fomenko, an economist with WCRI, said their report for 2015 compares Illinois’ fee schedule to Medicare and shows Illinois’ maximum allowable reimbursement rates are on average 69 percent higher for most services.

“And that places Illinois among the states with relatively higher workers compensation fee schedule rates,” Fomenko said.

Fomenko said the rates for various services range “from near Medicare levels for office visits to 339 percent above Medicare rates for major surgery.”

Fomenko said the majority of fee schedule states, which is all but a handful, use Medicare rates to set their fee schedules.

Jay Shattuck, executive director for the Employment Law Council with the Illinois Chamber of Commerce, said Illinois should do what it can to get back to the middle of the pack.

“We are not going to be able to compete for those better paying jobs that also offer outstanding benefits like healthcare and pensions with the high workers’ comp costs that we have,” Shattuck said.

With the exception of Indiana and Kentucky, Illinois is nearly surrounded by states without fee schedules.

Shattuck said that allows for some rate negotiation in those states. “The administrative side of it costs a little bit more,” Shattuck said, “and therefore there should be a little bit higher reimbursement rate over and above Medicare.”

Governor Bruce Rauner has been pushing for further reforms in workers’ compensation. Democratic leaders contend further reforms would push Illinois to the bottom while Rauner says Illinois should strive to be average.

“Are we reimbursing how much above the Medicare reimbursement level,” Shattuck said, “that’s where the real fight becomes between the payers and the medical providers.”