According to the IWCC, “emergency” Fee Schedule rules have been filed with the Illinois Secretary of State which have changed the implant reimbursement method and added accredited ambulatory surgical facilities to the ASTC schedule.
Medical treatment on or after July 6, 2010 should be paid according to the following new rules:
1. Reimbursement for a medical implant shall be 25% over the manufacturer’s invoice price less rebates, plus actual and customary shipping costs incurred for the implant.
2. In the Ambulatory Surgical Treatment Center (ASTC) fee schedule, facilities accredited for surgical treatment by either AAAASF, AAAHC, or JCAHO are eligible for the payment of ASTC facility fees.
We know that many of our clients are using third party vendors to reduce charges to the Fee Schedule rate. Please be sure that your partners have been made aware of these important new changes. The complete text of the new rules can be found here.
If you are an employer, insurer, or third-party administrator and have any questions about how this may impact you, please contact us.