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New York State Workers’ Comp Board Proposal Includes Two Potential Changes

New York State Workers’ Comp Board Proposal Includes Two Potential ChangesThe New York State Workers’ Compensation Board has introduced a proposal aimed at making several improvements in the overall medical treatment of injured workers. The proposal includes two potential major changes, as well as a few other enhancements. Combined with other recent Board initiatives, the board is hopeful that these changes will encourage more health providers to treat workers’ compensation claimants.

Workers’ Compensation Board Chair Clarissa M. Rodriguez commented on the proposal in a Board press release, saying that “Access to quality medical care for injured workers is of utmost importance for a healthy workers’ compensation system.” She also added, “When an injured worker has ready access to medical treatment, the worker heals and is restored to function more quickly and completely. Timely, high quality medical care benefits workers and their employers as well.”

The Board’s proposal is a direct response to workers’ compensation claimants’ challenges in finding treating providers, as well as the input received from health care providers around the obstacles that keep them from participating in the system, such as low fees and administrative complexity. By addressing these concerns and bringing more providers into the workers’ compensation system, the Board expects that injured workers will be able to more readily access the care they need.

Increased Reimbursement for Providers

The workers’ compensation fee schedule in New York State has not been substantially changed in over 20 years; the last major change being in 1996. The Board will be advancing a regulatory proposal in June to raise provider fees for services provided on or after October 1, 2018. The proposal will include an overall statewide fee increase for all provider types, with additional increases for certain specialty provider groups that have an extreme shortage of authorized providers. These new fees will ensure providers in New York are receiving fair and reasonable reimbursement for prompt, quality treatment to our injured workers.

A Universal Form

Input from providers has indicated that the paperwork requirements in the workers’ compensation system create a significant administrative burden. In response, the Board will be consolidating and eliminating forms, including converting to the use of the CMS-1500 form, the universal claim form used by medical providers to bill health insurers, and replacing the current Board treatment forms (C-4 and C-4.2, and equivalent OT/PT and PS forms) with the CMS-1500. This form is already used by medical providers and insurance carriers to process claims, so the Board anticipates an easy transition toward a January 1, 2019, implementation. This will save providers administrative time, effort and expense when treating workers’ compensation patients.

Additional Enhancements

The Board is making other improvements to increase provider participation and injured workers’ access to quality medical care, such as an online medical portal, which is an important step toward a paperless, easy-to-use system. Additionally, the Board is making a push to expand the types of providers authorized to treat injured workers. Currently, only physicians, chiropractors, podiatrists, and psychologists can be authorized, but a legislative solution is currently being suggested that would permit most medical providers such as nurse practitioners, physicians assistants, licensed clinical social workers and other providers who are licensed in New York State to become authorized to treat claimants within the workers’ compensation system.

About ASIA Workers’ Compensation

Associated Specialty Insurance Agency, Inc. has been “The Workers’ Compensation Specialist for Brokers and Agents” for the past two decades and is committed to providing brokers and insurance agents across the East Coast with expertise and services to develop a Workers’ Compensation policy. For more information about how we can assist you with claims management, anti-fraud measures, and more call (610) 543-5510 to speak with one of our professionals.

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