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July 6, 2009

Workers’ Compensation Inpatient Fee Schedules

The new Illinois Workers’ Compensation Commission (IWCC) MS-DRG hospital inpatient fee schedule can be viewed online by clicking here.

Please make sure that the appropriate personnel at your hospital are aware of the change. Specifically, as Medicare changed its inpatient coding from the DRG to the MS-DRG system, the IWCC is only now adapting to the change. As provided in IWCC rules, as of June 30, 2009, the inpatient fee schedule is to be in accordance with the MS-DRG codes. Thus, the current inpatient DRG schedule was re-run into an MS-DRG format in a budget neutral manner. To allow some transition time, the Workers Compensation Medical Fee Advisory Board and the IWCC ask providers and payers to cooperate and follow a July 31, 2009 effective date.

For dates of treatment prior to July 31, 2009, the inpatient fee schedule uses DRGs. Providers and payers should work to translate these bills using the CMS crosswalk, Grouper Version 24.0, available by clicking here.

Recall, that under workers’ compensation, the fee schedules do not necessarily represent the reimbursement amount your institution would receive for a workers’ compensation claim. Specifically, if you have a private contract then the contract rates prevail. Otherwise, the law specifies the maximum allowable payment for workers’ compensation medical treatment and procedures shall be the lesser of the health care provider's actual charges or the fee set by the schedule.