crime victims compensation program fee schedule implementation
TRANSCRIPT
History
Established in July 1986 A division of the Idaho Industrial Commission Served approximately 28,000 crime victims Paid approximately $36 million on behalf of
crime victims 2,384 new applications for benefits were filed
in FY09 Approximately 83% of the cases served by
the program involved criminal conduct against women and children
Funding Sources
Fines paid on criminal convictions Victims of Crime Act Grant (VOCA) Recovery efforts
Restitution—$287,386 Subrogation—$163,694
Donations
Benefits
Medical Mental health counseling Wage replacement Funeral Dependent death benefits Family assistance benefits Sexual assault forensic examinations
Eligibility
Crime must occur in Idaho 72-hour reporting requirement One-year filing requirement Cooperation
Prosecutor’s office Law enforcement
Victim’s conduct must not contribute to injury Felony/DUI mandatory reduction Third party payment sources Injuries that are direct result of the crime
What Is Not Covered?
Traffic related crimes Exceptions: DUI/BUI, intentional infliction,
hit and run Replacement of damaged or stolen
property Pain and suffering damages Pre-existing conditions
FY04 - FY09 Medical and Forensic Examination Payments
$1,619,072$1,687,689 $1,776,488
$2,575,009 $2,580,272 $2,614,907
1,500,000
1,700,000
1,900,000
2,100,000
2,300,000
2,500,000
2,700,000
FY04 FY05 FY06 FY07 FY08 FY09
Payment Information
Reasonable and customary charges Medical payment increases Proportionate reduction—April 2008
75% reasonable and customary Through June 30, 2010 No provision for balance billing
Payment Changes
Need for equitable compensation plan Idaho Code 72-1026
Adopts workers’ compensation medical fee schedule
Effective for services after July 1, 2010 Proposed administrative rule Payment may be considered payment in full
Reductions—may balance bill up to allowable amount
Must use UB04 or CMS 1500
Workers Comp Fee Schedule Establishes an allowable amount based
on Relative value unit x conversion factor CPT codes Place of service code Hospital size
Reimbursement Rates
Hospitals (inpatient) Large Hospitals (100 or more acute care
beds)—85% Small Hospitals (less than 100 acute care
beds)—90% Hospitals (outpatient)—80% Ambulatory surgery centers—80% Anesthesia—conversion factor multiplied
by base units plus time units
Reimbursement Rates (continued) Non-hospital services
Based on CPT code (RVU x conversion factor)
Services without an established CPT code—90%
Prescriptions Filled outside of hospital—90%
Surgically implanted hardware Actual cost plus 50%
Notification
Explanation of benefits Issued at time of payment Indicates CVCP payment Advise of any balance that may be billed to
claimant
Notification
Denial Notice Issued at time of denial Indicates denial reason Advises claimant of appeal rights
Notification
Claims status report Issued on the 15th of each month Indicates status of all pending claims for
each provider