Resolution of Medical Billing Disputes
NY-ADR
1/29/20 N.Y. St. Reg. WCB-45-19-00010-A
NEW YORK STATE REGISTER
VOLUME XLII, ISSUE 4
January 29, 2020
RULE MAKING ACTIVITIES
WORKERS' COMPENSATION BOARD
NOTICE OF ADOPTION
I.D No. WCB-45-19-00010-A
Filing No. 33
Filing Date. Jan. 14, 2020
Effective Date. Jan. 29, 2020
Resolution of Medical Billing Disputes
PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following action:
Action taken:
Amendment of sections 300.19, 325-1.25, 440.8, 442.3; and repeal of section 325-1.24 of Title 12 NYCRR.
Statutory authority:
Workers' Compensation Law, sections 13-g, 117 and 141
Subject:
Resolution of medical billing disputes.
Purpose:
Incorporate the 2019 changes to WCL section 13-g into existing regulations.
Substance of final rule:
Section 300.19: Amended to add third-party administrator, to define medical bills as any authorized medical provider of Medical Care (as defined in section 325-1.25), to add new provider types, conform arbitration paragraphs to the statute and delete (n) through (o) and add an effective date of January 1, 2020.
Section 325-1.25: Add employer and third-party administrator throughout, defines Medical Care, adds new provider types, simplifies billing dispute process to eliminate “continuous course of treatment” concept and extend time to file from 90 days to 120 days, and adds an effective date of January 1, 2020.
Section 440.8: Deletes the existing text and replaces with: Bills for prescribed medicine shall be paid in accordance with the fee schedule established by section 440.5 of this Part and section 325-1.25 of Part 325 of this Chapter. Objections to a bill for prescribed medicine shall be filed in accordance with section thirteen-g of the Workers’ Compensation Law and section 325-1.25 of Part 325 of this Chapter as well as adding an effective date of January 1, 2020.
Section 442.3: Deletes the existing text and replaces with: Bills for durable medical equipment, medical/surgical supply, or orthotic or prosthetic appliance shall be paid in accordance with the fee schedule established by section 442.2 of this Part and section 13-g of the Workers’ Compensation Law. Objections to and resolution of billing disputes shall be in the format and according to the process prescribed by the Chair and as set forth in section 13-g of the Workers’ Compensation Law and section 325-1.25 of Part 325 of this Chapter.
Final rule as compared with last published rule:
Nonsubstantive changes were made in section 442.3.
Text of rule and any required statements and analyses may be obtained from:
Heather MacMaster, Workers' Compensation Board, Office of General Counsel, 328 State Street, Schenectady, NY 12305, (518) 486-9564, email: [email protected]
Revised Regulatory Impact Statement, Regulatory Flexibility Analysis, Rural Area Flexibility Analysis and Job Impact Statement
A revised Regulatory Impact Statement, Regulatory Flexibility Analysis, Rural Area Flexibility Analysis and Job Impact Statement are not required because the changes made to the last published rule do not necessitate revision to the previously published document. These changes do not affect the meaning of any statements in the document.
Initial Review of Rule
As a rule that requires a RFA, RAFA or JIS, this rule will be initially reviewed in the calendar year 2023, which is no later than the 3rd year after the year in which this rule is being adopted.
Assessment of Public Comment
The agency received no public comment.
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