Illinois Proposes PPP Rules

     The Illinois Department of Insurance has published its' proposed rules for Preferred Provider Programs (PPPs) under 2011's House Bill 1698.  There will now be a 45-day period where comments regarding the proposed rules can be submitted to either Joe Clennon or Susan Anders at the Illinois Department of Insurance.  The full document is available here and begins on page 6356 of the Illinois Register.

     This was the next step in the implementation process of the PPP.  Once the rules are finalized, Alpha Review will be conducting a followup webinar to the one we conducted in January.  If you were unable to attend the first one, it is available on our website for free viewing.  If you would like to be notified when the second webinar is scheduled, please contact John McDonald at (630) 305-8108 or e-mail him at jmcdonald@alphareview.com.

AMA Supports IAIABC Model Rule for Medical E-billing

     On April 25, 2012, the American Medical Association (AMA) issued a press release stating they are endorsing the IAIABC model rules for medical e-billing.  The IAIABC calls for "adopting a nationally-recognized set of uniform standards to guide electronic billing in the workers' compensation system."  This is important because states such as Georgia, Texas and Minnesota already have some form of e-billing initiative in place based on the IAIABC model rules.  Furthermore, other states including Illinois, North Carolina, California and Louisiana are in various stages of adopting similar initiatives based on this model.

     According to the release, the cost of processing an electronic claim is 46% less than the cost of processing a paper claim.  The full press release can be found here.

     Alpha Review Corporation is in the process of putting together a series of educational webinars regarding the e-billing initiatives being adopted by various states.  If you would like to be notified when these are going to take place, please contact John McDonald (630) 305-8108 or e-mail him at jmcdonald@alphareview.com.

WCRI Medical Price Index

     Recently, the Workers' Compensation Research Institute released their "WCRI Medical Price Index for Workers' Compensation, Fourth Edition (MPI-WC)."  Among the findings in this report, which studied 25 large states that make up approximately 80% of the workers' compensation benefits paid in the United States, are:

• States with no fee schedule have higher prices paid and more rapid price growth than states with fee schedules.
• In states with certain types of services not covered by their fee schedules, price growth for those services was often more rapid than for services covered by the fee schedule.

The full, free report can be found here.  The report is rather lengthy but has a lot of good information.  Should you have any questions, please contact John McDonald at (630) 305-8108 or e-mail him at jmcdonald@alphareview.com. 

IWCC Proposes Rules Updating Medical Fee Schedule Changes

     The Illinois Workers Compensation Commission (IWCC) has issued proposed rules to amend the medical fee schedule to reflect the changes made in legislation passed in 2011.  These amendments implement the changes that were included in HB 1698, such as:

• 30% reduction to the fee schedule
• New reimbursement for medical implants

     The proposed rules can be found here.  Should you have any questions, please contact John McDonald at (630) 305-8108 or e-mail him at jmcdonald@alphareview.com.

WCRI Illinois Baseline Report

     Recently, the Workers Compensation Research Institute (WCRI) released its "Baseline for Monitoring the Impact of 2011 Reforms in Illinois: CompScope Benchmarks, 12th Edition" report.  The purpose is to provide some baseline information to evaluate the impact of HB 1698.  Some of the highlights of the report are below.  All figures are prior to the 2011 reform.

• Medical costs per claim were the highest of the 16 states in the study.
• Indemnity benefits per claim with more than seven days of lost time were 33% higher than the median state.
• The Illinois fee schedule enacted in 2006 is 180% above Medicare, the second highest in the nation among states with fee schedules.

     The full report can be purchased here.  HB 1698 did address a number of the cost drivers detailed in the report.  In addition to the 30% reduction in the fee schedule, the introduction of the Preferred Provider Program (PPP) and e-billing should help reduce costs.  To assist with these changes, Alpha Review will be hosting another educational webinar regarding e-billing in Illinois.  Please let John McDonald know if this is of interest to you.

     If you have any questions, please contact John McDonald at (630) 305-8108 or e-mail him at jmcdonald@alphareview.com.  

Pennsylvania Proposal for Reform

     According to the 2010 study by the Oregon Department of Consumer & Business Services, Pennsylvania has the 14th highest employer costs in the nation.  As a result, the Pennsylvania Chamber of Business and Industry has drafted a proposal for reform that would update the state's workers' compensation system.  Some of the proposed changes are:

• Allowing mandatory drug testing if Schedule II narcotics are prescribed and allow employers to use one or more Prescription Benefit Managers (PBM).
• Updating of the medical fee schedule.

     The full proposal can be found here.  Alpha Review will keep you posted as changes occur.

Express Scripts Unveils Fraud Detection

     Earlier this week, Express Scripts introduced their new Comprehensive Fraud, Waste and Abuse (FWA) program for their workers' compensation clients.  The following is an excerpt from their press release (of which the full version can be found here) that briefly describes the program.

"The new Express Scripts program offers a suite of services that can identify fake or forged prescriptions, overprescribing, prescriber-patient collusion, and injured worker identity theft or drug-seeking behavior."


     Prescription drugs now account for approximately 19% of treatment expenses for workers' compensation patients.  It is because of this that Alpha Review and Express Scripts are working together to identify and eliminate fraudulent practices and charges.  If you have any questions or would like some more information on how to take advantage of this new program, please contact us at info@alphareview.com.