April 17, 2018
New Medical Provider Fee Schedule and Simplified Medical Reporting Will Attract More Health Care Providers to Treat Workers' Compensation Patients, Make Process Easier for Providers
The New York State Workers' Compensation Board announced today a proposed increase in medical reimbursement to providers who treat workers' compensation claimants and also the adoption of a universal claim form to drastically reduce paperwork in workers' compensation claims. Coupled with other new Board initiatives such as an online medical portal and a push to broadly expand the types of providers authorized to treat injured workers, these enhancements will encourage more health providers to treat workers' compensation claimants.
"Access to quality medical care for injured workers is of utmost importance for a healthy workers' compensation system," Workers' Compensation Board Chair Clarissa M. Rodriguez said. "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 proposals come in direct response to claimants' challenges in finding treating providers, and concerns from health care providers around low fees and administrative complexity that keep some from participating. By addressing these concerns and bringing more providers into the workers' compensation system, injured workers can more readily access the care they need.
Increased medical reimbursement
The New York State workers' compensation fee schedule has not changed substantially since 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.
Accepting the universal form
Providers have indicated that the unique paperwork requirements in the workers' compensation system result in significant additional administrative burden. Therefore, 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.
Other enhancements
The Board is also committed to making other improvements to increase provider participation and injured workers' access to quality medical care. This includes development of a medical portal, part of the 2013 Business Process Re-engineering initiative, which will allow providers to quickly and easily identify whether their course of treatment is consistent with the Board's medical treatment guidelines and, if not, advise them that a variance is needed. The Medical Portal is an important step toward a paperless, easy-to-use system.
Additionally, the Board continues exploring ways to broadly expand the universe of providers who can be authorized to treat injured workers. Currently, only physicians, chiropractors, podiatrists, and psychologists can be authorized. Governor Cuomo supports a comprehensive legislative solution that would permit most medical providers who are licensed in New York State to become authorized to treat within the workers' compensation system, opening participation to medical providers such as nurse practitioners, physicians assistants, licensed clinical social workers, and other providers.
CONTACT: publicinfo@wcb.ny.gov