In a Board Panel Decision dated May 24, 2017, the Board found that the Medical Treatment Guidelines apply to the out of state treatment of a claimant residing outside of New York State. The decision in In Re Hospice is important because it reverses the Board’s previous statements that out-of-state treatment was immune from the application of the restrictive Medical Treatment Guidelines (“MTG”). This meant that New York claimants merely had to “cross the river” into New Jersey or any other state and obtain medical treatment and medications which far exceeded the treatment or medications allowed under the Medical Treatment Guidelines, needlessly increasing the costs in their cases. Now employers and carriers have a Board Panel decision supporting the argument that law judges should apply the MTG’s to out of state cases. Continue reading Medical Treatment Guidelines Apply to Out of State Claimants→
Opioids is one of the hottest topics in the workers’ compensation arena. As a result of the epidemic across the country, the New York Workers’ Compensation Board has implemented new procedures to address opioids. You can locate our recent articles about opioid abuse, requesting a weaning program with the assistance of the Non-Acute Pain Medical Treatment Guidelines, and the recent Board Bulletin released by the Workers’ Compensation Board that reiterates a growing need to stop the proliferation of long-term opioid use. Continue reading Emergency Room Opioids?→
Timeline of the “Typical” case: Admitted Traumatic Accident with Lost Time.
Initial investigation to confirm loss.
If there is medical and lost time, begin benefits.
File FROI-00 (Electronic Data Interchange, “EDI”).
File update EDI documents as the case progresses.
The Board’s initiative to enforce EDI (“eClaims”).
Beginning in 2013, the Board has begun an increased tempo of “monitoring and compliance” initiatives intended to enforce the eClaims guidelines and generate more penalty income for the State. The Board has now established a “Compliance Unit” intended to do the following:
monitor performance standards for timely submission of First Report of Injury,
confirm timely first payment of indemnity benefits,
check for timely submission of Subsequent Report of Injury showing first payment,
monitor timely submission of Controversy; and
track the Percentage of Claims Controverted (how many cases is the carrier denying?).
The New York Workers’ Compensation Board announced the creation of a Medical Portal to enable electronic submission of C-4AUTH, MG-1 and MG-2 authorization requests. The portal will provide users with real time status of requests and send a notification when a status changes. The Board claims that users will no longer need to know which form to complete when submitting a request and the portal’s user interface will ask the user questions, the answers will determine the correct path and type of treatment authorization request.
Use of the portal is not required
Health care providers may continue to submit requests using the paper forms, if they choose. It is anticipated, however, that electronic submission will make the approval process faster, reduce errors, improve data quality, and eliminate the need to submit paper authorization forms. Additionally, if a health care provider submits a treatment authorization request electronically, the payer will be required to respond to the request electronically. If the medical provider submits a paper form, the payer must respond in kind via paper submission.