Archive for the ‘WORKERS' COMPENSATION UPDATES’ Category

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Workers’ Comp. – Injured Workers In-Person Sessions:

Tuesday, October 15th, 2013

As you should know, the WCB is currently in the process of holding sessions around the State to listen to persons comments about what works and what doesn’t work in the WC Program.  The WCB is in the process of revamping/re-engineering the system.  Please see the following link -

http://www.wcb.ny.gov/BPR/InPersonSessions.jsp

You and treating WC physicians can send your questions and/or comments to: BPR@wcb.ny.gov

Please be sure that your patients/injured workers know about these new sessions for them -

Injured Workers In-Person Sessions:

Event

Location

Date

Time

Injured Worker Day All Board Offices
Across New York
Monday, November 4, 2013 9am – 3pm
Injured Worker Day All Board Offices
Across New York
Monday, December 2, 2013 9am – 3pm
Injured Worker Day All Board Offices
Across New York
Monday, January 6, 2014 9am – 3pm

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Workers’ Compensation Business Process Re-engineering

Tuesday, September 17th, 2013

The Board has teamed with Deloitte to analyze the existing workers’ compensation system in New York. The goal of this business process re-engineering (or BPR) project is to significantly improve the experience of injured workers and employers in the New York workers’ compensation system.
Your ideas, thoughts, and comments are critically important to the success of the BPR project. Therefore, we are conducting open forum discussions in our district offices to initiate a conversation and gather your input regarding the current and future state of the workers’ compensation system in New York. A “starter” list of discussion topics appears below.
Discussion Topics
1. Do you believe the workers’ compensation system in New York is working well for injured workers and employers?
2. What works well today and what does not?
3. As a provider, what do you think would be the one impactful change that would benefit injured workers in the system?
You can participate via webinar, in a discussion in one of our district offices, or through both venues.
Webinar
To attend the webinar, please click the link below to register and launch the webinar. Due to the large number of attendees for each webinar, attendees can only provide their feedback through comments/questions typed in the webinar chat box. First time attendees: Please review in advance setup instructions posted on our website http://www.wcb.ny.gov/BPR/Events. Select WebEx Instructions.

The Board has teamed with Deloitte to analyze the existing workers’ compensation system in New York. The goal of this business process re-engineering (or BPR) project is to significantly improve the experience of injured workers and employers in the New York workers’ compensation system.

Your ideas, thoughts, and comments are critically important to the success of the BPR project. Therefore, we are conducting open forum discussions in our district offices to initiate a conversation and gather your input regarding the current and future state of the workers’ compensation system in New York. A “starter” list of discussion topics appears below.

Discussion Topics

1. Do you believe the workers’ compensation system in New York is working well for injured workers and employers?

2. What works well today and what does not?

3. As a provider, what do you think would be the one impactful change that would benefit injured workers in the system?

You can participate via webinar, in a discussion in one of our district offices, or through both venues.

Webinar

To attend the webinar, please click the link below to register and launch the webinar. Due to the large number of attendees for each webinar, attendees can only provide their feedback through comments/questions typed in the webinar chat box. First time attendees: Please review in advance setup instructions posted on our website http://www.wcb.ny.gov/BPR/Events. Select WebEx Instructions.

Date

Time

Link

Wednesday, Sept 25

8am – 9am

1. Go to http://bit.ly/1g6yDcM 2. If requested, enter your name and email address. 3. Click Join.

OPEN MEETINGS

RSVP

RSVP at bpr@wcb.ny.gov to reserve your spot today!

Brooklyn

111 Livingston Street 22nd Floor, Brooklyn

Monday, Oct. 7

5:30pm – 7pm

Queens (Jamaica)

168-46 91st Avenue,3rd Floor, Jamaica

Tuesday, Oct. 8

4pm – 5pm Or 5:30pm – 7pm

Hempstead


220 East Rabro Drive, Suite 100, Hauppauge


Wednesday, Oct. 9

4pm – 5pm

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WC Chair Implements Desk Arbitration of Health Care Billing Disputes

Friday, August 9th, 2013

Date: August 9, 2013

The Business Relief Act provides for desk arbitration by a single arbitrator to resolve health care billing disputes involving $1,000 or less. In addition, providers may opt for desk arbitration when the amount in dispute exceeds $1,000. The Workers’ Compensation Board (Board) has modified its procedures and Form HP-1 to implement these changes.

Desk arbitration involves dispute resolution by a single arbitrator based on paper submission, rather than a hearing before an arbitration panel. The HP-1 with an original signature must be submitted with a check for the arbitration fees. The provider and carrier/self-insured employer each have 30 days from the Board’s acknowledgement of the arbitration request to submit any documentation in support of its position. This evidence can be submitted in writing or by referencing a document present in the Board file. After the time for submission has expired, an arbitrator chosen by the Chair will review the evidence and issue a written decision.

Desk arbitration has several advantages. It allows for quicker resolution of disputes and facilitates grouping of disputes involving similar services to be reviewed by an appropriate arbitrator. It also enables the parties to avoid having to appear in person for medical billing disputes that can be readily resolved by paper submission.

To facilitate the new rules, Form HP-1, Health Provider’s Request for Decision on Unpaid Medical Bill(s), has been revised. The HP-1 now includes a check box to allow providers to select desk arbitration if more than $1,000 is in dispute. The Board will automatically assign any claim involving $1,000 or less to desk arbitration. New arbitration fees have been established, with reduced fees for desk arbitration. The new fees are as follows:

Amount in Dispute Desk Arbitration Panel Arbitration
$0–$1000 $50 –––
$1000.01–$5,000.00 $150 $250
$5,000.01 + $300 $500

The new form and filing fee schedule take effect on September 1, 2013. All requests for arbitration made on or after September 1, 2013 will require use of the new form which includes a revised fee schedule.

Questions about arbitration of disputed health care bills should be directed to the Medical Director’s Office at (800) 781-2362.

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Chair Announces Adoption of ICD-10 Starting on October 1, 2014

Monday, August 5th, 2013

Date: August 2, 2013

As previously announced in Subject No. 046-485, “Chair Announces Board Intends to Adopt Use of ICD-10 on a Timetable Consistent with Medicare and Medicaid”, the NYS Workers’ Compensation Board (Board) has begun planning the adoption of the International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10).

All medical providers and institutions covered by the Health Insurance Portability Accountability Act (HIPAA) will be required to transition to the ICD-10. Although workers’ compensation systems are usually excluded from HIPAA requirements, the Board expects that Board-authorized medical providers will be making the transition to ICD-10 for other medical payers. To avoid the costs to providers associated with supporting two diagnostic coding systems and to maintain consistency with other medical systems, the Board will also be requiring use of ICD-10.

The Board intends to align the timing of its adoption of ICD-10 with the Center for Medicare and Medicaid Services’ (CMS) IDC-10 implementation date, October 1, 2014. The Board will also begin requiring its providers to use the ICD-10 code sets on October 1, 2014.

The Board remains ready to provide whatever support stakeholders may need regarding the transition to ICD-10.

If you have questions about ICD-10 and its impact on New York’s workers’ compensation system, please email us at provider@wcb.ny.gov. The CMS web site is also an excellent resource for ICD-10 information. Please visit the Centers for Medicare and Medicaid Services website for timelines, resources, statute and regulations, and the latest news on the CMS transition.

Robert E. Beloten
Chair

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Centralized Mailing Address for All Board Offices – Effective Immediately

Monday, September 17th, 2012

Please alert your staff to the following important information regarding Workers’ Compensation claims - As of January 1, 2013 mail should no longer be sent to any of the district office addresses.

The new centralized mailing address, which is effective immediately, is:

New York State Workers’ Compensation Board

Centralized Mailing Address

PO Box 5205

Binghamton, NY 13902-5205

Full details concerning this change are addressed in the following link containing the WCB notice: http://www.wcb.ny.gov/content/main/SubjectNos/sn046_91.jsp

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2012 NYS Guidelines Available on WCB Website

Tuesday, November 8th, 2011

The New York State Workers’ Compensation Board (WCB) has released the 2012
NYS Guidelines for Determining Permanent Impairment and Loss of Wage
Earning Capacity (2012 Guidelines), which will go into effect on January 1,
2012.  The WCB will provide web-based education programs for physicians and
other stakeholders beginning in mid-November.  Continuing medical education
credits will be available.
Please refer to the WCB Subject Number SN046-472 and the WCB website
at www.wcb.state.ny.us for full details.
Robert E. Beloten
Chair

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Workers’ Compensation Board Chair to Appoint Medical Advisory Committee

Wednesday, June 1st, 2011

May 31, 2011

FOR IMMEDIATE RELEASE

In December 2010, the New York Workers’ Compensation Board (Board) adopted four Medical Treatment Guidelines for the treatment of injuries to the neck, shoulder, back, and knee. Developed by the Insurance Department’s Workers’ Compensation Reform Task Force and its Advisory Committee, these guidelines create a standard of care using the most effective medical treatments as determined by medical evidence and a consensus of well-respected medical experts.

The Board is committed to keeping the existing guidelines current with evolving medical knowledge and practice. It also intends to develop additional guidelines for treatment of other work-related conditions, following the principles of evidence-based medicine.

To assist in these important tasks, the Chair intends to appoint a Medical Advisory Committee (MAC). The MAC will consist of highly respected medical experts with diverse medical backgrounds and will make recommendations to the Chair. It will be co-chaired by the Board’s Medical Director and Associate Medical Director, Dr. Jaime Szeinuk of Mt. Sinai Medical Center and Dr. Elain Sobol-Berger. Its first task will be to develop guidelines for the management of chronic pain disorders.

The NYS AFL-CIO and the Business Council of New York State will each nominate three medical professionals for appointment to the MAC. The Chair will also appoint three medical professionals based on applications and nominations received from individuals and medical associations throughout the state. The Committee will consult with additional subject matter experts in various health care disciplines, as necessary.

The Board seeks physicians who are recognized as experts in their field. Physicians with the following specialties and sub-specialties are encouraged to apply:

  • Anesthesiologist/pain management
  • Family medicine, internal medicine, or general practice
  • Neurology
  • Neurosurgery
  • Occupational and environmental medicine
  • Orthopedic surgery
  • Physical medicine and rehabilitation
  • Psychiatry

Nominations should include the individual’s name, contact information, CV, and a brief statement of interest. They should be submitted to MACnominations@wcb.state.ny.us on or before June 15, 2011.

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A REALLY Useful WC Page!

Friday, February 11th, 2011

Dear Doctors,

For those of you (or your office staffs) who are dealing with Workers’ Compensation patients, the following web page should be really really useful.  It will help to inform you of who is handling variance requests at the WC carrier involved in your patient’s case.  It will tell you which carriers are participating in the Optional Prior Approval Process, whereby you would file the MG-1 Form.  In addition, it will identify who should receive your request for authorization (C-4 auth Form) at the WC Carrier.  The page also will identify which WC Carriers have chosen not to participate in the optional Prior Approval Process.

In the third paragraph on the page, you or your staff will be able to link to a component that will help you find the WC Carrier for the employer – just in case you don’t have that information.

https://www.wcb.state.ny.us/MTGContact/MTGContactSearch.jsp?searchContacts=Search+for+Carrier+Contacts+and+Participation

At the bottom of this WCB web page, you will also find the email address and 1(800) phone number for the Medical Director’s office at the WCB.  There is also a link for their help desk.

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New Workers’ Compensation Brochure — “Get the Facts on Medical Treatment Guidelines”

Tuesday, January 18th, 2011

Many medical providers requested that a brochure be created to educate injured workers on the new Medical Treatment Guidelines. “Get the Facts” on Medical Treatment Guidelines, is a brochure issued by the NYS Workers’ Compensation Board. This brochure is available on the Board’s website at:

http://www.wcb.state.ny.us/content/main/Workers/MTGFacts.pdf

The link is case sensitive.

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Rules on Failure to Treat WC Patients

Thursday, January 6th, 2011

NEW YORK CODES, RULES AND REGULATIONS, NYCRR 325-1.21 provides in part that a physician, “shall accept and treat such injured employees in a manner corresponding to that accorded other patients in his or her practice, without discriminating against such injured employees because they are or may be covered by the provisions of the Workers’ Compensation Law”.  The full text of NYCRR 325.21 is included below.

Section 325-1.21 Failure to treat.

A physician, podiatrist, chiropractor, psychologist, operator of a medical bureau or laboratory authorized by the chair to render treatment and care to injured employees under the Workers’ Compensation Law:

(a) shall accept and treat such injured employees in a manner corresponding to that accorded other patients in his or her practice, withoutdiscriminating against such injured employees because they are or may be covered by the provisions of the Workers’ Compensation Law; and

(b) shall not refuse to provide treatment and care to such injured employees on the basis of a fee request greater than that set forth in the applicable prescribed fee schedule, but shall submit to arbitration such fee dispute in accordance with the provisions of the Workers’ Compensation Law, nor shall such treatment and care be denied to such injured employees because the source or manner of payment for such treatment and care is pursuant to the provisions of the Workers’ Compensation Law.

Nothing contained in this section shall prevent a voluntary payment by the employer or carrier of an amount higher than the fees and charges found in the fee schedule where agreed to by the employer or carrier. An authorized physician, podiatrist, chiropractor, psychologist, operator of a medical bureau or laboratory whose actions violate or are inconsistent with the provisions of this section shall be charged with misconduct, and his or her authorization to treat workers’ compensation cases shall be subject to suspension or revocation by the chair in accordance with the procedures set forth in the Workers’ Compensation Law.

Q. What is the consequence of Failure to Treat?

A.   A provider can be removed from the list of authorized providers.

Q.  If a physician can’t take on any new WC claimants, would the WCB consider this reportable misconduct?

A.  If a provider is removed from the list of authorized providers, it is reportable to DOH.

Q.  What if the practice cannot financially sustain any more WC claimants?

A.  As the regulation states, “shall accept and treat such injured employees in a manner corresponding to that accorded other patients in his or her practice, without discriminating against such injured employees because they are or may be covered by the provisions of the Workers’ Compensation Law.”

Q.  As an example under managed care, doctors may feel they need to close their panel since it is not economically sustainable to take on new plan patients.

A.  The only acceptable reason not to take on new WC patients is if the practice is not taking on ANY new patients.

Q.  What is the alternative if a physician feels h/she cannot sustain the financial viability of the practice without limiting the number of WC claimants?

A.  The physician may have to turn in their authorization to treat WC patients and cease treating all WC patients.

Q.  Are you saying that the physician has no discretion to limit the number of WC claimants?

A.  Their discretion is limited only to the extent that they may refuse a new WC patient if the practice is not accepting ANY new patients.

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