Fee Schedule
 

Prior to the year 2006’, the good State of Illinois did not have a fee schedule for Worker’s Compensation.  In February of 2006’ The State of Illinois Workers Compensation Division adopted a new Fee Schedule that was to be followed by all Hospitals and Independent Practicing Physician’s and Facilities.  This was necessary due to the blatant disregard by many independent Physician’s and facilities over charging for services rendered and then expecting to get paid within the Workers Compensation system at 100%. 

Most all of these Physician’s and independent facilities should have been following a standardized reasonable and customary fee schedule per Geo-Zip already available by at least 4 different National Clearing Hoses such as INGENIX.  These clearing houses work by gathering averages of numerous treatment codes that are submitted for payment to insurance companies all across the country.  These numbers are collected from all the different insurance companies that turn in the data per zip code which then is analyzed by companies like INGENIX.  These fees are recorded by each and every practicing Doctor, Hospital and Independent Facility when their billing has been introduced and recorded by different insurances.  These fees come from each and every code that has a value and then the average is noted for each zip code.  Since some fees are very high and others very low, the average is recorded and then there are values placed in the 90th percentile, 80th percentile, 70th percentile, 60th percentile...all the way down to Medicare rates. 

The good State of Illinois and its legislators and working citizens of the Work Comp board have reviewed the numbers and came up with utilizing the 80th percentile as reasonable fees and secondly allowed INGENIX to assist them with this difficult task.  This is a very healthy reimbursement rate and there should be absolutely no complaints.  But apparently, the insurance companies that do business here in this good State are not able to make enough monies to properly make timely reimbursements to the good Physician’s and Surgeons who take on these very difficult cases.  Because of the political issues throughout the State and the State and many local cities that are on the verge of filing Bankruptcy, many insurance companies are suffering too and why they have been pushing for lower fee schedules and increased difficulties for reimbursement by more complicated Utilization Reviews, more power and credibility to IME’s and so forth.  This of course is not good considering it is already extremely difficult to get paid as it is from these good companies due to their development of Local and State wide financial disasters.

We bring this to your attention that we can issue some assistance independent from all of this and coming only from our facility located here in the Lake County district.  As a premier Independent Facility in the field of Workers Compensation and having an in-depth understanding of how things work and further, working hand in hand with numerous insurance companies and claims adjusters on a regular basis, we want to make it clear that we would like to assist by LOWERING our fees below the fee schedule that will mean several hundreds of thousands of dollars each year in savings to the insurance companies that we work directly with. 

Why are we doing this?  We feel that it is necessary to contribute to a good cause.  Lowering medical standards is not part of this cause but rather, lowering the costs of some or most of our procedures based solely in this office anywhere from 2%-10%.  We are also open to independent contracts with any insurance companies that wish to work with our facility on a more regular basis.  We are looking to build more trust between Doctor’s and the Insurance companies and would also like to bring to pass a savings to the insurance company as long as the insurance company is fair and reasonable with us, allowing authorization where needed, for services that are medically necessary to cure and/or relieve the patient of their injury.

In conclusion, a better system and a contribution that we feel will make some sort of impact considering that most others are at or above the Fee Schedule.  Our lowered fees will be for all examinations, all listed x-rays, unlisted procedure codes, all Physical Medicine codes, and finally, any/all other codes utilized within this facility specific for things such as HEP assistance, Taping and Splinting codes, Reports and Reporting and much more.  Although we also provide Surgery’s and other Medical assistance such as Pharmaceuticals, these are with different vendors that we work with and trust but have no say over their fees of record.  However, our fees take the breadth and depth of the services provided from this region and specific location and we can assure you once again that these will make a difference over a 12 month period.

Please see below numbers and comparison of the current 2011 fee schedule and our newly adopted fees.  This is also part of a newly adopted program that has been adopted under the new management and the new name SPINE and JOINT INSTITUTE of LAKE COUNTY, Inc.

EXAM CODES and FEES

New Patient Exam

Billing Code W/C IL Fee Our Fee % Reduction
/ Diff
99201 $82.84 $78.70 5%
99202 $115.32 $109.55 5%
99203 $167.75 $159.36 5%
99204 $235.90 $224.10 5%
99205 $293.56 $278.88 5%

ESTABLISHED PATIENT EXAM

Billing Code W/C IL Fee Our Fee % Reduction
/ Diff
99211 $45.08 $42.83 5%
99212 $73.38 $69.71 5%
99213 $94.81 $90.07 5%
99214 $141.55 $134.47 5%
99215 $218.09 $207.18 5%

PHYSICAL MEDICINE MODALITIES

Billing Code W/C IL Fee Our Fee % Reduction
/ Diff
97140 $59.76 $53.78 10%
97014 $41.95 $39.85 5%
97032 $52.41 $47.17 10%
97010 $36.70 $34.86 5%
97035 $47.19 $44.83 5%
97112 $52.41 $47.17 10%
97012 $41.95 $37.75 10%
97018 $41.95 $39.85 5%
97039 $47.12 $35.81 76TH%
98940 $47.19 $45.77 3%
98941 $57.66 $55.93 3%
98942 $68.15 $64.74 5%
98943 $47.19 $45.77 3%

PHYSICAL THERAPY CODING

Billing Code W/C IL Fee Our Fee % Reduction
/ Diff
97545 $193.96 $192.02 1-2%
97110 $62.90 $61.64 1-2%
97116 $41.95 $39.85 5%
97530 $52.41 $49.79 5%
95831 $65.01 $65.01 0%
95832 $90.17 $85.66 5%
95833 $104.84 $99.60 5%
95834 $72.33 $68.71 5%
97750 $73.38 $66.04 10%
95851 $78.61 $70.75 10%
95852 $50.32 $47.80 5%

SPECIALIZED CODING

Billing Code W/C IL Fee Our Fee % Reduction
/ Diff
90901 $173.00 $173.00 0%
64550 $188.72 $186.83 1-2%
96002 $78.64 $77.85 1-2%
93740 $104.84 $102.74 2%
96004 $104.84 $104.84 0%

 

X-RAY CODING

Billing Code W/C IL Fee Our Fee % Reduction
/ Diff

*(All “7” codes across the board have been reduced 5%



**All other fees that have not been listed will be either billed at Fee Schedule or under.   Surgical, Mammograms, MRI, NCV/EMG, Epidural Injections and so on, will be billed at Fee Schedule.

CONCLUDING COMMENTS:

Our fees change each year and depending on our success with this reduction will depend on whether or not we will be able to continue the reduced fees.  We will consider contracts with certain insurance and employer companies for even further reduction but will need to be negotiated in person and will depend on the amount of volume referred.  Our fees change at the first of each year in the month of January and will change usually only 1-2% up or down.  All our fees in this facility are for PPO insurance patients, Workers Compensation, Standard Private Insurance, Cash Patient’s, Personal Injury Patient’s and so on and go by these fees as shown.
These fees are conservative and reasonable.

***(To access the Illinois Fee Schedule directly on line with the Department of Financial and Professional Regulations go to:
http://iwcc.ingenixonline.com/download.asp and you will see the fees for each and every CPT code established by the AMA.)

 
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Spine and Joint Institute | 2634 West Grand Avenue, Suite 100 Waukegan , IL 60085 | Tel: (847) 775-0800
 
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