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2012 NYS Guidelines and Fee Schedule
- Treatment Guidelines:
Mid and Low Back
- Treatment Guidelines FAQs
- Fee Schedule
Guidelines for Determining Permanent Impairment & Loss of Wage EarningCapacity
The Workers' Compensation Board has developed the 2012 New York State Guidelines for Determining Permanent Impairment and Loss of Wage Earning Capacity for use by medical professionals, carriers, and attorneys. The Board is offering free web training on these new 2012 Guidelines.
Rules on Failure to Treat WC Patients
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
05/07/2012- ICD-10 Transition: Chair announces NYS Workers' Compensation Board intends to adopt use of ICD-10 on a timetable consistent with Medicare and Medicaid.
12/01/11 - Comment Sought on Proposed CTS Guidelines. The NYS Workers' Compensation Board has just released draft Medical Treatment Guidelines for Carpal Tunnel Syndrome and is seeking your comments in electronic form at CTSGuidelines@wcb.state.ny.us on or before December 1, 2011. The full request from the WCB can be found through the following link http://www.wcb.ny.gov/content/main/SubjectNos/sn046_447.jsp
11/ 24/2010- New Health Provider Fee Schedules, Effective December 1, 2010: The Chair of the Workers' Compensation Board has adopted regulations to implement new health provider fee schedules that will take effect on December 1, 2010, the same day that the Medical Treatment Guidelines take effect. The text of the regulation and the supporting documents are on the Board's web site. The new fee schedules include the following changes:
- 30% increase in Evaluation and Management (E&M) services in the medical and podiatry fee schedules.
- Restructuring the chiropractic fee schedule to allow chiropractors to bill separately for individual treatment modalities rather than billing for an office visit that includes all treatment.
- Addition of ground rules that adopt the Medical Treatment Guidelines as the basis for treatment to the mid and lower back, neck, shoulder and knee.
- Update Current Procedural Terminology (CPT) codes to accommodate changes made by the American Medical Association (AMA) in 2009 and 2010. As a result, the new schedules include new and changed CPT codes, and eliminate deleted CPT codes.
- Minimal typographical changes.