Illinois Workers' Compensation Reform - Things to Watch

Initial reviews of the changes made to the workers’ compensation law have shown multiple areas where physical therapists and physical therapist assistants may be affected.

Reimbursement

1. According to the Illinois Workers’ Compensation Commission, all current fee schedules will be reduced by 30% for all treatment performed after September 1, 2011.

2. Beginning in January of 2012, Illinois will move from 29 geo zips to 14 zones for hospitals and 4 for physicians and other providers. These zones will be based on the boundaries of specified counties.

Utilization Review

1. Providers are now required to submit written utilization review requests, and to make reasonable efforts to submit timely and complete reports to support a request for certification of requested treatment. If such reasonable efforts are not made, the charges may not be compensable or collectable.

2. If an employer or its agent refuses to pay for services based on a legitimate utilization review, the petitioner has the burden of establishing that variance with the guidelines are warranted in the particular situation.

PPP (Preferred Provider Program)

1. Employers are allowed to establish a PPP of medical providers approved by the Department of Insurance. As of this writing, there is not any approved workers’ compensation PPPs. To see a list of companies as they are approved, click here.

2. The employee must be notified of the program, and can opt out in writing any time.

Billing and Collections

1. Payers must inform providers of insufficient information in billing within 30 days and imposes a 1% monthly interest fee after 30 days. Previously, the law allowed 60 days.

For a full summary of the changes made in the law, click here.