This is from the Vice President of James Skelton, Esq., from AAA today (4-23-18) – It is for everybody’s edification:
Dear Jason – The Workers’ Compensation Board has recently advised the Department that the following email regarding PT rules is not the Board’s official position. If you have any questions, please contact Chris Maloney at [email protected] or (212) 480-5586.
Christopher Maloney
Supervising Insurance Examiner
Property Bureau – Claims Administration Unit
New York State Department of Financial Services
One State Street Plaza, 6th floor, New York, NY 10004+1511
Ph: (212) 480-5586 | Fax: (212) 709-1570 | [email protected]
www.dfs.ny.gov
From: MacMaster, Heather (WCB)
Sent: Tuesday, January 30, 2018 3:59 PM
To: Maloney, Chris (DFS) <[email protected]>
Cc: Woods, MaryBeth (WCB) <[email protected]>; Smith, Steven (WCB) <[email protected]>
Subject: Fee Schedule: PT rules
Chris:
Here is the PT information from our MDO.
The 8 RVU limitation is per patient per day regardless of how many body parts are treated or how many practitioners treat. The only exception is with chiro and PT. If a chiro renders manipulation only (98940-98943) and does not bill any of the other physical medicine codes, the injured worker could receive chiro and PT on the same day. This scenario is usually performed by a chiro who is affiliated with the Chiropractic Council. They only perform manipulation.
The physical medicine codes that are impacted by the 8 RVU limitation are in the chiro physical medicine fee schedule but the codes for spinal manipulation are not in the general physical medicine fee schedule.
Thanks,
Heather
Heather MacMaster
Deputy General Counsel
NYS Workers’ Compensation Board
328 State Street, Schenectady, NY 12305
(518) 486-9564 | [email protected]
http://www.WCB.NY.Gov
Confidentiality Notice: All contents of this message, including any attachments, may be confidential and/or legally privileged. Contents are intended for the recipient only. Any other use, dissemination or disclosure is unauthorized. If you are not the intended recipient, please notify the sender and delete the message and any attachments immediately.
James Skelton
Vice President
American Arbitration Association
32 Old Slip, 33rd Floor, New York, NY 10005
www.adr.org
T: 917 438 1562
Our office has moved. The new address is 32 Old Slip, 33rd fl, New York, NY 10005
The information in this transmittal (including attachments, if any) is privileged and/or confidential and is intended only for the recipient(s) listed above. Any review, use, disclosure, distribution or copying of this transmittal is prohibited except by or on behalf of the intended recipient. If you have received this transmittal in error, please notify me immediately by reply email and destroy all copies of the transmittal. Thank you.
6 Responses
OK, now that we know what the Board’s official position is not, what is it then?
If their position is not “The 8 RVU limitation is per patient per day regardless of how many body parts are treated or how many practitioners treat,” It could be their position the 8 RVU limitation is PER practitioner?
Looks to be they are taking a hands off position now. It is irresponsible.
From what I understand, AAA was perfectly happy to allow the email to be used in the awards, but unwilling to provide a copy of it. Once it got out there, and disavowed, suddenly they want to keep everyone abreast of the situation?
This was poorly handled all around.
There is a certain undercurrent of which you are not aware. WC exists in a secretive vacuum. The ALJ’s are staff members of comp and do what they are told. Thus, the ALJ’s apply 8 units across the spectrum (I suspect ** Awaiting FOIL response to prove this **) and apply the Medicaid ground rules for CPM (was told this) after an adverse 2016 board decision. Therefore, WC does not want to publish opinions, get into the middle of any disputes or expose what goes on behind closed doors. Suffice it to say, DFS went out on a limb to get the opinion and then had to eat spoiled pie when WC did what they always do: turn the other cheek.
Dont lie the WCB didnt take a hands off approach.
the carriers should do what the WCB wants the carriers to do when a chiro and a PT treat patient on same day:
deny the charges as concurrent care, then prove the care was duplicative,
http://www.wcb.ny.gov/content/main/hcpp/MedicalTreatmentGuidelines/FAQs.jsp
but then that would cost way more than some BS coder affidavit