CRIME VICTIMS COMPENSATION PROGRAM - PowerPoint PPT Presentation

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CRIME VICTIMS COMPENSATION PROGRAM
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CRIME VICTIMS COMPENSATION PROGRAM

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  1. CRIME VICTIMS COMPENSATION PROGRAM Fee Schedule Implementation

  2. 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

  3. Funding Sources • Fines paid on criminal convictions • Victims of Crime Act Grant (VOCA) • Recovery efforts • Restitution—$287,386 • Subrogation—$163,694 • Donations

  4. Benefits • Medical • Mental health counseling • Wage replacement • Funeral • Dependent death benefits • Family assistance benefits • Sexual assault forensic examinations

  5. 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

  6. 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

  7. Cases Filed By Crime Type – 2009

  8. Victims Served by Age

  9. Payments by Service Type

  10. Payment Information • Reasonable and customary charges • Medical payment increases

  11. FY04 - FY09 Medical and Forensic Examination Payments

  12. 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

  13. 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

  14. Workers Comp Fee Schedule • Establishes an allowable amount based on • Relative value unit x conversion factor • CPT codes • Place of service code • Hospital size

  15. 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

  16. 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%

  17. Notification • Explanation of benefits • Issued at time of payment • Indicates CVCP payment • Advise of any balance that may be billed to claimant

  18. Notification • Denial Notice • Issued at time of denial • Indicates denial reason • Advises claimant of appeal rights

  19. Notification • Claims status report • Issued on the 15th of each month • Indicates status of all pending claims for each provider

  20. Contact Us Crime Victims Compensation Program700 S. Clearwater Lane P.O. Box 83720Boise, ID 83720-0041208-334-6080 800-950-2110Fax 208-332-7559www.crimevictimcomp.idaho.gov