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WC Advocacy

 

CMS-1500 Update

(This information was provided to NYPTA by the NYS Workers' Compensation Board on March 29, 2019)

This is a quick update to let you know that the CMS-1500 project is moving forward and that the Workers’ Compensation Board will inform you when the implementation phase of the project will begin. The Board recently released an onboarding guide for XML Submission Partners (clearinghouses) to prepare for testing in late April 2019. Check here to see the status of XML Submission Partners with whom you currently partner.

We also want to take this opportunity to clarify whether a payer can reject a medical bill/report received prior to the employer’s notice of the underlying injury. They cannot. Since the medical report must be filed within 48 hours of the first medical exam, the first medical report could be filed before the employer notifies the payer that there has been a workplace injury, and so before the payer submits the FROI.

Please stay tuned for additional updates, and monitor the CMS-1500 section of the Board’s website for the latest information, including updates about phase one of the project, upcoming training and the most recent FAQs. 

If you have any questions, please email CMS1500@wcb.ny.gov.

 


 

The NYPTA is offering members a widget to calculate the impact of the recent reforms to the NY WC Medical Fee Schedule (MFS).  The modernized fee schedule is set to be enacted on April 1, 2019.  The widget allows members to enter their clinic's zip code to determine the specific rates for initial evaluations, re-evaluations and follow-up visits.  A map is also displayed, allowing a user to click on one of the four geographic regions to determine the reimbursement rates for their area.  Fees will ultimately depend on the services billed and the duration of care provided.  A direct comparison graphically illustrating the existing MFS rates to the updated rates is included for reference.  The updated WC Medical Fee Schedule is now available for purchase at the following link:  https://www.optum360coding.com/Product/40508/

 


 

 

 


 

Physical Therapy Receives Significant Payment Increase from NYS Worker Compensation Board

 

On December 26th, the New York State Workers’ Compensation Board adopted regulations which substantially increase payment for physical therapist services provided to injured workers effective April 1, 2019.   The last time the Board revised payment for physical therapist services was back in 1996.  This increase has been a long-standing goal of NYPTA, and we greatly appreciate the work of the members who participated in our advocacy effort.  We will be releasing a more detailed summary of anticipated changes soon. In the interest of disseminating information quickly, the following provides some brief FAQs on the changes.

 

Did the Conversion Factor Increase?

 

Yes, the conversion factor for physical therapist services increased from 21 to 30 percent across the 4 regions of the state.  The average conversion factor increase across all 4 regions was 25.4%

 

Did the RVU Caps Increase?

 

Yes.  Initial evaluations are capped at 18 RVUs, revaluations are capped at 15 RVUs and follow up visits are capped at 12 RVUs, all of which allow for a greater intensity/duration of medically necessary treatment to be provided per session.

 

What does this mean in terms of payment?

 

Payment for an episode of care will depend on the type and intensity of services provided; however, we anticipate that the changes will lead to a meaningful increase in payment, possibly doubling of the current rate of payment. This increase is a combined function of the conversion factor increase AND the increase in covered treatment per session with the higher RVU caps.

 

When will the Changes Take Effect?

 

The changes in the fee schedule will take effect April 1, 2019.

 

Will the changes include a hard cap of 12 visits/180 days?

 

No. The Workers’ Compensation Board had proposed a hard cap of 12 visits/180 days but eliminated the proposal from the adopted regulations based on NYPTA and other's comments.

 

Did my Participation in Advocacy Help?

 

Unquestionably Yes!  Insurance companies objected to the RVU increases; however, in response, the Board stated the following: “The Board received over 600 comments objecting to [the current RVU caps] in the previous proposal and increased to 12 in this proposal, so no change has been made [to the RVU cap increases].”

 

Working Together

 

NYPTA is committed to advancing the profession of physical therapy and the interests of our members. This is a long overdue victory for the profession and is a direct result of combined NYPTA, AIPT, and individual member efforts.  The Workers’ Compensation fee increases is a great example of what we can achieve when we work together.

 


 

NYPTA recently submitted additional comments to the NYS Workers' Compensation Board regarding a change in visit/time restrictions for the physical medicine guidelines.  The deadline for comments on the second iteration of the proposed changes has now been reached and we are awaiting the Board’s final proposal.  Once we receive that, we will be able to advise our members exactly what changes have been made.  


 

NYPTA’S ADVOCACY ON WORKERS COMP RATES ENTERS NEXT CRITICAL PHASE WITH PUBLIC CAMPAIGN 

 

NYPTA’s advocacy to increase workers’ compensation rates for PT services has entered a critical new phase with the launch of a campaign designed to raise public awareness of PT services as an effective alternative to prescription opioids. As NYPTA has steadfastly maintained, research has proven PT services to be a clinically effective and cost effective alternative to prescription opioid use.

 

The launch of the public campaign follows weeks of advocacy by NYPTA and its membership that generated numerous public comment submissions to the state Workers’ Compensation Board (WCB). To see NYPTA’s formal comments on the proposed rate changes, click here. The rate schedule proposal is pending with the WCB, and a final schedule is expected to be released in October.

 

The implications of the comp rate increase extend far beyond just workers’s comp payments, however, given that many commercial insurers use the state’s workers’ comp rates as a basis for their own rate schedules.

 

The public campaign, which is supported by AiPT, features statewide targeted digital ads and radio ads in the Albany, NY market. The campaign seeks to educate the public and lawmakers about NYPTA’s “Injured Worker Opioid Alternative Initiative.” At the core of the plan is an increase to the current worker’s comp PT rate schedule, and an increase to the RVU cap on follow-up PT services. The RVU cap currently in place artificially limits the amount of care that injured workers can receive, which is a key factor driving New York’s injured worker opioid utilization rates far higher than the national average.

 

Other states, including Colorado and Washington, have employed similar means to incentive PT as an opioid alternative and have been successful in significantly lowering the number of opioid prescriptions written for injured workers, reducing not only opioid drug costs, but lowering the incidence of opioid addiction, abuse and overdose.

 

Governor Cuomo has been a vocal champion in New York’s efforts to fight opioid abuse. NYPTA’s advertising campaign seeks to encourage the Governor to add the “Injured Worker Opioid Alternative Initiative” to the list of his administration’s accomplishments in reducing the over-reliance on these addictive substances. 


In The News

 

NYPTA Executive Director Kelly Garceau and Public Policy Committee member Brendan Sullivan were recently interviewed on Spectrum TV's "Capital Tonight" - one of New York's most watched political news programs.  The interview features NYPTA's "Injured Worker Opioid Alternative Initiative."  To view the segment go to: 

http://spectrumlocalnews.com/nys/capital-region/capital-tonight-interviews/2018/09/06/physical-therapy-opioid-crisis?cid=share_sms

 

Additional coverage of the initiative was published in the Albany Times Union at: 

https://m.timesunion.com/news/article/NY-physical-therapists-say-reimbursement-change-13213381.php

 


 

NYPTA Comment Letter

 

Click here to view the NYPTA Comment Letter sent to the Workers Compensation Board on July 9, 2018.

 


 

 
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