Improved Medical Care for Workers a Major Agenda in New York Workers’ Comp Board Proposal

by | Published on Jul 18, 2018 | Workers Compensation

More providers need to be attracted to providing medical services for injured workers so that workers gain improved access to medical care. With this in mind, the New York Workers’ Compensation Board has proposed a medical fee schedule that would increase provider payments by 5%. A reduction in paperwork is also proposed. This fee schedule would affect medical, podiatry, chiropractic and psychological treatment. Medical record analysis is utilized to establish the medical necessity of the treatments provided to the worker and the nature of the injury or illness. New York has a $10 billion-a-year workers’ compensation system, and the entities involved hope that the proposal will simplify the current complicated system that is characterized by heavy paperwork and long waits. Those areas experiencing shortage in medical providers authorized to treat injured workers could witness further increases over the proposed 5% increase. This is with a view to increase the number of authorized providers for workers injured on the job. The proposal points out that since 1996, there has been no increase in the fees paid to medical providers who treat injured workers in New York State.

The proposal, which is a multipart one, recommends the following:

  • Increase medical providers’ compensation fee schedule, effective October 1, 2018.
    • An overall state-wide fee increase is proposed for all provider types. Additional increases may be there for certain specialty provider groups that have acute shortage of authorized providers.
    • The new fee schedule would ensure that providers in New York are receiving fair and reasonable payment for timely, quality treatment provided to injured workers.
  • Effective January 1, 2019, adopt the CMS-1500 form that is universally used in the insurance industry for every other kind of claim.
    • It has been brought to the Board’s notice that the unique paperwork requirements in the workers’ compensation system create considerable additional administrative burden.
    • The Board expects, by January 1, 2019, an easy transition to the CMS-1500 form that is already used by insurance carriers and medical providers to process claims.
    • This transition is aimed at saving providers administrative time, effort and expense when treating workers’ compensation patients.
  • Expand the list of medical professionals authorized to treat injured workers. Nurse practitioners, physician assistants, and licensed social workers would be included in the list.
  • Create an online medical portal that will advise medical providers whether their proposed course of treatment for a patient meets the workers’ compensation board’s guidelines. If it doesn’t, providers would be advised that a variance is needed.

According to many provider groups, these proposed changes are badly needed. For instance, according to Julie Shaw, CEO of OrthoNY, a medical group that sees patients for office visits or surgery 210,000 times a year at 10 Capital Region offices welcomes the proposed changes. She says that only around 8% of their patient visits involve workers’ comp claims. But at least 25% of their employees in their claims processing office are dedicated strictly to workers’ comp cases. The paperwork became so burdensome that they had to outsource it to a New Jersey company. Even then, they still need three people dedicated to workers’ comp in its 28-person claims office. According to Ms. Shaw, the burdensome things included doing the paperwork, getting authorization for care, and the long wait time to get reimbursed for the care provided. The wait time is worse for patients who are injured and in pain. Often, they have to wait a long time to get approval for their surgeries. So, she hopes that the new proposals will bring about welcome changes in the system.

The cost of the system is very likely to go up, with the increased treatment reimbursement passed on from insurers to the businesses that employ workers. However, as Lev Ginsburg, director of government affairs for the Business Council of New York State, points out, the changes implemented in 2017 which the Council estimated would yield a half-billion dollars in savings to New York employers, may at least partially offset the higher costs resulting from the 2018 proposals.

Providers, insurers and employers consider the proposed changes positive and necessary. When nurse practitioners and physician assistants are included in the care team, it may help reduce costs and the higher reimbursements could reduce the temptation to commit fraud.

Along with healthcare providers, insurers and employers, workers’ compensation lawyers and the medical record retrieval companies that support them all endorse the fact that access to quality medical care for injured workers is very important to ensure a healthy workers’ compensation system. Easy access to medical treatment would help the worker to heal quickly and get back to work. This is something that employers want so that the business functions without disruption and extra costs need not be incurred on recruiting and training replacement staff.

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