Insurance News:

JLTF Pleased to Report Positive Response from WCB on Proposed New Medical Fee Schedule

by Joint Legislative Task Force | 7/15/2015 9:49:13 PM

The New York State Chiropractic Association (NYSCA) and the New York Chiropractic Council (the Council) are pleased to report further progress has been made to secure a fair and reasonable chiropractic fee schedule. On July 2, the NYS Workers’ Compensation Board (WCB) Medical Director Dr. Elaine Sobol-Berger informed us via letter that some of our recommendations to the WCB were used to modify the proposed Medical Fee Schedule (MFS) Discussion Document. While the WCB did not adopt all of our recommendations, this is a positive step, and we will continue to work with the WCB on this matter.

If you recall in July 2014, the WCB first proposed a new MFS that was submitted for public comment. We have consistently been urging and working with the WCB to update the fee schedule in a manner that was fair to chiropractic. The new proposed fee schedule incorporated billing and payment practices based on the Medicare reimbursement model for providers and payers in the state Workers’ Compensation system. This raised several serious concerns as Medicare limits chiropractic reimbursement to 98940-42 services. These most recent developments are a continuation of efforts including listening to our patient’s concerns, meeting with elected officials, testifying to a joint hearing of the Assembly Labor and Insurance Committees, and ongoing communications with the WCB.

On June 19, 2015, we submitted a researched and detailed letter to the WCB expressing our continued concerns about the proposed MFS, and offered suggestions to make the MFS more appropriate in regards to services rendered by a doctor of chiropractic. As stated above, the WCB did modify the proposed MFS based on some – but not all – of our recommendations. Specifically, we have seen an expansion in the new patient E/M codes, addition of supervised electrical stimulation, and confirmation that electrodiagnostic testing can be rendered and reimbursed by a chiropractor. A few other recommended changes were denied based on their interpretation of the limitations contained within the chiropractic scope of practice. We are unsatisfied with the WCB’s opinion that parity in certain fees is unwarranted based on this interpretation. This, and other concerns remain, and we will continue our efforts to advocate for appropriate reimbursement for chiropractic care rendered to injured workers.

We have been assured by the WCB that their intent is not to limit reimbursement for services rendered by a doctor of chiropractic, and we will continue to advocate for policies in line with this. We are encouraged with the WCB’s July 2 response and thankful for their efforts to work with us to find the best solution, but we also believe there is room for improvement. We remain dedicated to ensuring that chiropractors are reimbursed, in the same manner as all other health care providers, for all medically necessary services rendered according to the WC Medical Treatment Guidelines. We are presently preparing a response to the latest WCB letter and will keep you apprised of our work and how you might be able to help.

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