There is a new ambulatory fee schedule for the New York State Workers' Compensation cases, according to a Business Insurance report.
Here are five key notes on the change:
1. The New York State Workers' Compensation Board adopted the new fee schedule, changing reimbursement methodology, which some providers fear makes cuts to pain management reimbursement and reduces orthopedic surgeon reimbursement rates.
2. The New York State Association for Ambulatory Surgery Centers requested the board reconsider their changes during the public comment period between September and October of 2016. However, the board declined.
3. The reimbursement will be 150 percent of Medicaid, and Medicaid and Medicare made cuts to base rates associated with pain management, according to the report. The board denied the new fee schedule reduced orthopedic surgeon reimbursement.
4. The board transitioned to ICD-10, which could be difficult for unready payers.
5. Some providers expressed concerns spinal cord stimulator methodology doesn't permit separate reimbursement for the stimulators which could affect payments, but the methodology does incorporate payments for other implants within the total cost for procedures consistent with Medicaid and other plan.