Synopsis: Thoughts from Two Experts on the Coming Crisis that is IL WC SB 904.
Editor’s comment: Below you will see more thoughts from Dr. David Fletcher who is a strong proponent of the new legal model of IL SB 904 that may divide resolution of workers’ comp claims in this State between our IWCC and the Circuit Courts in the 102 Counties across this State. You may note Dr. Fletcher is concerned about timely collection of WC medical bills, the addition of statutory interest to such billing and the IL WC Medical Fee Schedule. I would comment on my view that IL SB 904 doesn’t directly address adjudication of the accurate medical fee schedule amounts due and owing to a treating doctor or other healthcare giver.
For myself, my colleagues on both sides of the IL WC Bar, numerous insurance carriers and TPA’s, I want to challenge the members of Illinois Workers’ Compensation Commission, the IL WC Advisory Board, the IL WC Lawyers Association and all other interested persons and organizations to stop sitting on their hands about this proposed legislation. The Illinois State Medical Society and Dr. Fletcher repeatedly indicate they have the votes and will rapidly override the Governor’s amendatory veto in the November fall legislative veto sessions. When and if that happens, the IL WC system is going to be shaken to its core. In my view, the number one benefit in WC across the globe is medical care and the number one priority of any effective WC system should be proper and timely payment for medical care rendered.
I have been advised the folks at ISMS feel there is an obvious legislative anomaly in not allowing doctors, hospitals and other caregivers to have standing to collect medical bills on accepted claims. A similar issue applies to the legislation that provided these same businesses with the ability to charge reasonable interest rates on such billing. In general, I agree with their concerns and last week proposed we look to other states for better solutions than IL SB 904.
The main complaint of IL healthcare givers is patent—the IL WC system is dramatically flawed if they have no legal or administrative “standing” to rapidly collect medical billing and statutory interest. I strongly agree with them and assert we need legislation and a strategy to allow doctors, clinics, hospitals and other medical caregivers to rapidly and smoothly use the services of the IL WC Commission to resolve their billing issues and GET PAID.
The main issue with IL SB 904 isn’t the overall goal—it is the problem with creating parallel venues to adjudicate WC issues. In my view this concept isn’t going to work nearly as well as the proponents of this bill feel it is. This is going to create a crisis this troubled state doesn’t need with Circuit Court judges that know little about workers’ comp being asked to become experts on it. Everyone also feels every unpaid WC medical bill may lead to litigation, causing an explosion of lawsuits unlike any this industry has ever seen.
I am sure the legislative experts at the IL State Chamber of Commerce and Governor Rauner are correct—we need to move/correct/retain these medical/legal issues at the IWCC now and forever.
If you want more details on my overall concerns, send a reply. The next part of this is from Dr. Fletcher. I send him my appreciation and thanks for letting me share it with you.
Commentary on the Amendatory Veto for IL SB904 by David Fletcher, M.D., M.P.H.
The Illinois medical community is very disappointed that Governor Rauner issued an amendatory veto (AV) on SB904 that was ghostwritten by his cronies at the Illinois Chamber of Commerce, which continue to propagate the myth that Illinois has the 2nd highest medical fee schedule in the country, when in fact the most common service (evaluation and management codes better known as office visits) are reimbursed 85% below the national median and ranks Illinois as the 43rd lowest in the country.
The point that Governor Rauner, the Illinois Chamber (which fails to advocate my business interests by despite being a dues-paying member), and others opposing SB 904 fail to acknowledge is that the medical community needs an effective solution right now. SB 904 is not about reform, it’s about enforcing current law.
Illinois physicians who render services to patients covered under the provisions of the Illinois Workers’ Compensation Act, 820 ILCS 305, are to be compensated for their services pursuant to the provisions of 820 ILCS 305/8.2. As part of that compensation, physicians are entitled to receive statutory interest on their unpaid bills as set forth in 820 ILCS 305/8.2(d)(1-3) at 1% interest per month.
Serving for the past eight years on the Illinois Workers Compensation Research Institute (WCRI) Advisory Committee I have consistently pointed out to the last three IWCC Chairmen Weisz, Latz, and Fratianni), who also serve on this WCRI committee, that this interest provision is a joke.
I can provide hundreds of examples that demonstrate that WC insurers have skirted the law regarding interest payments. For example, I had a recent case with Liberty Mutual (08WC012059, McCool v Conair Corp) that the arbitrator ruled on 1/22/18 in favor of the injured worker who got hurt in December 2007. My bills went unpaid for a decade despite my efforts that got this patient back to work. Currently, I have $3,420.38 in unpaid interest payments for services I rendered 10 years ago, yet I had to bear upfront all the overhead and labor costs of my practice to care for this injured worker. I have no avenue to recover and my complaint to the Illinois Department of Insurance went unresolved, who instructed me to work it out with Liberty Mutual.
Likewise, why no electronic claims 7 years after the 2011 WC reform law mandated it? Other states have electronic claims for WC claims as it is done currently in Illinois with commercial health insurers for non-work-related claims
By rejecting SB 904, Governor Rauner also allows insurers to continue ignoring these mandatory electronic billing requirements enacted in 2011. These insurers are clinging to an all-paper based billing system that delays care and payments (and insurers make money on the float with delay in or non-payment of services). Because there has been no enforcement of existing law, I have to employ a full-time person to process paper bills and pay for postage to submit these paper bills. I would be able to eliminate overnight $65,000 a year in operating costs if SB 904 becomes law with its original language overwhelmingly passed by super majorities in both houses in May 2018.
The Illinois Chamber wants to keep the unpaid interest dispute in the hands of the Illinois Workers’ Compensation Commission (IWCC).
The esteemed editor of this blog Gene Keefe last week wrote a commentary regarding SB904 and advocates a system like in Indiana (and such a system exists in Wisconsin) that
gives doctors and hospitals a say and, most important, legal standing before their Indiana work comp Board to fight for payment of unpaid medical bills whereby the claimant is left out of the process.
While I would welcome a similar medical fee adjudication system in Illinois since I currently have absolutely no avenue to collect on unpaid bills, the medical community cannot count on the IWCC to fix these pressing issues. As it operates now the IWCC is not prepared to take over enforcement of existing law. Sadly, the IWCC has cancelled 4 of its last 7 Medical Fee Advisory Board meetings, including the meeting scheduled for today (September 17, 2018)
It’s disappointing that MFAB meeting is cancelled once again, especially since the Commission is well aware of the problems facing medical providers that is trying to be addressed in SB 904. If the Rauner administration was serious about setting up a whole new process at the Commission to handle medical billing disputes, don’t you think they would be setting up an emergency MFAB meeting to discuss with the Medical Community
State Sen. Michael Hastings, (D-Tinley Park) the chief sponsor of SB 904 was quoted as saying in the Work Comp Central trade publication: “It’s garbage that the governor thinks it’s OK for doctors to not get paid….This bill would have protected Illinois physicians as job creators and would have ensured that injured workers are returned to work as soon as possible.”
It is the systematic failure of the Illinois workers compensation system that drives physicians away from taking care of injured workers, which creates access to care problems, that end up costing businesses more money.
The Governor fails to recognize that access to quality care that SB904 help address is the real cost savings for employers. Sadly, he ignored the recommendations of his own Republican leadership which urged him to sign the bill.
In closing the medical community is encouraged that our message that access to care is being threatened due to non-payment of services has been heard loud and clear by both sides of the aisle in Springfield. The first week of the fall veto session starts Tuesday, November 13 and we work our legislators to override the AV. We believe that SB904 will become law with the amendment intact that was proposed by Jay Hoffman, Democrat, who heads the House labor committee.
David J. Fletcher – MD, MPH
Medical Director, SafeWorks Illinois
Synopsis: CALLING ALL CHARITABLE GOLFERS !!! Sept 29th is your chance to help make a difference in the lives of children with brain cancer.
Editor’s comment: As many of our clients and fans of the KCBA update are already aware, we work hard to support charities which touch our lives. Please consider playing in the 3rd Annual Kiss of Hope Open. The Open will be held on September 29th with a 12 noon shotgun at Randall Oaks Golf Course in West Dundee. The day will include many on-course contests, raffle prizes, silent auction AND a helicopter ball drop! KCBA is sponsoring a refreshment cart as well-so come have a refreshment with the Bierys! Gather your group and click on the link http://ckmc.org/golf2018/ to register to play and make a difference.
Cancer Kiss My Cooley® is a 501c(3) charitable foundation that was created in memory of a very special boy, Carter Kettner. Carter was the 6 year old son of Joe and Cinnamon Kettner. At age 5, he was diagnosed with an inoperable malignant brainstem glioma on February 17th, 2009. He loved singing, watching movies, and riding his John Deere tractor. His thoughtfulness and appreciation towards others was unfounded. He was a perfect gentleman, and met every girl with a kiss on the lips. His illness didn’t make him the boy he was; cancer was just something that happened to him. He continued to live every day, trusting his mommy and daddy. He loved his crazy little brother Bowen, and he laughed though his antics, calling him a beast and a freak. He loved his hospitals, doctors and nurses, and did everything that was ever asked of him. Carter was perfection in a son. He was indeed, the meaning of HOPE. Carter passed away 15 months into his journey (on Shawn Biery’s birthday) and after living through this terrible journey and receiving an outpouring of support, the Kettner’s decided that other families living with cancer should share in similar blessings. So, in December 2010, Carter’s parents came together with an extraordinary group of individuals who were always dubbed “Carter’s Crew”. They incorporated together to form cancer kiss my cooley. CKMC® was named after a phrase that Carter used to say when receiving treatment. We called his backside his “cooley”, which is Italian slang for “rear end”. He would sing “cancer kiss my cooley!” pointing to his backside. Since Carter’s passing and this new idea, the phrase has taken on new meaning. We want to show families that they can also tell cancer to “kiss it”! Live your lives with cancer; fight, yes – but live; make memories, and keep HOPE. So indeed, the Kettner journey did not end; it will continue on.
So please consider taking some time to spend September 29th making a difference at Randall Oaks Golf Course in West Dundee. Click on the link http://ckmc.org/golf2018/ to register to play or contact Shawn Biery at firstname.lastname@example.org for more details.