Health Care Efficiencies                                                   Issue 3

Most perioperative medications do not require prior authorization

As a reminder for health care providers, the New York Workers’ Compensation Drug Formulary includes a perioperative drug list – a list of medications that do not require a prior authorization request (PAR) for treating an injured worker during the perioperative period.  The perioperative period is the period of time four days before through four days following a surgery.

Detailed guidance for medical billing disputes now available

The Board has created a new medical billing disputes section of our website with important guidance for health care providers about submitting a Request for Decision on Unpaid Medical Bills (Form HP-1.0), along with detailed information on the arbitration process.  This includes required documentation and recommended actions for common scenarios as well as answers to the Board’s most frequently asked questions regarding billing disputes.

Reminder: Enhanced reimbursement for primary care, behavioral health providers

In case you missed it, the Official New York State Workers’ Compensation Medical Fee Schedule (2019) includes two ground rules that provide for 20% enhanced reimbursement for certain specialty providers to increase provider participation in those areas. Ground Rule 17, the Designated Provider Enhanced Reimbursement, established the Board-specific modifier 1D, which provides a 20% reimbursement increase to providers with Board-assigned rating codes and services in the primary care fields (family medicine, general practice, and internal medicine). Ground Rule 18, the Behavioral Health Provider Enhanced Reimbursement, established Board-specific modifier 1B, which provides a 20% reimbursement increase to providers with Board-assigned rating codes for designated services in behavioral health. For more information on the Medical Fee Schedule, see our Medical Fee Schedules page on the Board’s website.

Questions?