WC BOARD SUSPENDS USE OF CONTROVERSIAL MEDICAL REPORT FORM
In response to a growing health care access problem for injured workers in the greater Rochester area, New York State Workers’ Compensation Board (WCB) Chair Robert Beloten this week suspended the requirement that the use of any of the C-4 series of forms, whether those mandated in 2009 or previous versions, be utilized in the six-county region surrounding Rochester. According to the WCB release, “authorized physicians, podiatrists, chiropractors and psychologists in the Provider Shortage Area may submit a CMS-1500 with a detailed narrative report or office notes in lieu of one of the prescribed C-4 forms.”
Since other medical providers across other counties in New York State have continued to express concerns regarding the implementation of these forms into their practices, WCB Chair Beloten has also rescinded statewide the requirement that physicians treating injured workers use the newly expanded (2009) family of C-4 forms, and instead may use the previous version of the C-4 form, which is far simpler, but still requires that some version of the C-4 form be used. According the WCB release, “In all areas of the State, the Board will enforce payment in accordance with the Workers’ Compensation Law and regulation regardless of the version of the C-4 form used to report examinations, services and/or treatments rendered by providers.”
MSSNY member Dr. Jeffrey Kahn, a Syracuse physiatrist who chairs the MSSNY Committee on Workers’ Compensation and No Fault Insurance, has led an effort since 2007 when the WCB first disclosed its intent to implement these new C-4 forms, to convince the WCB to significantly alter its proposed plans regarding the use of any new C-4 forms. Dr. Kahn and other physician leaders informed the WCB that the use of these new forms would impose significant new administrative burdens on physicians across New York State, and potentially cause some physicians to leave the Workers’ Compensation program altogether. We are pleased that some of the MSSNY recommended changes were incorporated, as well as the WCB’s integration of Dr. Kahn’s recommendations to offer both paper and electronic versions of the C-4 forms with a centralized fax submission system. Nevertheless, both MSSNY and the New York State Society of Orthopedic Surgeons (NYSSOS) have continued to object to the usage of these forms, even after their implementation, due to the hardship to many medical practices regarding both the time and costs forced upon medical providers who have attempted to remain in compliance.
A related concern is the fact that physician reimbursement for treating injured workers has not been increased since 1994. In several recent meetings between the WCB with Dr. Kahn and MSSNY, the WCB has acknowledged the need for an increase in these fees to bring them to a level consistent with the type of care provided as well as the financial burdens placed upon physician practices due to the new C-4 forms. The Board and MSSNY are working with the Governor’s office to achieve such an increase. The New York State AFL-CIO has also advocated for such an increase. MSSNY will continue to advocate to assure that a fair and reasonable fee schedule increase for treating injured workers is implemented as soon as possible.
This entry was posted
on Monday, February 1st, 2010 at 10:36 am and is filed under WORKERS' COMPENSATION UPDATES.
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