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This is not an April fools joke, it is really happening. Effective 01 April 2019, all WC claims will be paid using the new and increased formula released by the NYWCB. As many medical practices know that the WC fee schedule has not changed for the past 9 years, and many doctors have stopped seeing worker comp patients due to lack of reimbursement and many different problems with worker comp carriers. I am not going to discuss the various problems with worker comp carriers, I will say that out of 100 claims only 50-60 % get paid or even less for some doctors due to lack of information in their billing department or contracted billing companies. This is implemented to improve the quality of Healthcare for patients and for Medical Providers.
Now, let’s talk about medical reimbursement fees.
Effective 04/01/2019 conversion factor and RUV (Relative Value Unit ) is getting changed.
There is a conversion factor for each geographic region and general type of medical service provider (e.g., E&M, surgery radiology or maybe medicine.)
The region is divided into 4 parts, Region 1 and 2 will be identical, I mean medical reimbursement fees will be the same.
The fee schedule is updated for Medical (It’s for all specialties), behavioral health, Chiropractor/PT dental, pharmacy, DME and podiatry.
DME codes are not covered by worker comp, however, DMEs are covered with a specific CPT code and its subject to invoice cost and other things.
Now you must be wondering that if I can show some quick example so you can get a clear idea about changes, see below for the difference between the updated and old rates. (Region I and Region II are not identical on old Fee Schedule but they are Identical on the New Fee Schedule)
99204: $114.20 (Old)
99204: $163.85 (New) Difference: $49.65
99214: $71.40 (Old)
99214: $102.45 (New) Difference: $31.05
99244: $181.96 (Old)
99244: $261.10 (New) Difference: $79.14
· Region II:
99204: $119.60 (Old)
99204 : $163.85 (New) Difference : $44.25
99214: $74.89 (Old)
99214 : $102.45 (New) Difference : $27.56
99244: $190.60 (Old)
99244 : $261.10 (New) Difference : $70.50
· Region III
99204: $136.78 (Old)
99204: $187.39 (New) Difference: $50.61
99214: $85.53 (Old)
99214: $117.17 (New) Difference: $31.64
99244: $217.97 (Old)
99244: $298.60 (New) Difference: $80.63
· Region IV
99204: $148.69 (Old)
99204: $203.76 (New) Difference: $55.07
99214: $92.97 (Old)
99214: $127.40 (New) Difference: $34.43
99244: $236.94 (Old)
99244: $324.69 (New) Difference: $87.75
I have mentioned only 3 very commonly use CPTs by most of the medical providers, this new fee schedule is applicable on all billable codes, again DME fee schedule depends on invoice cost. Medical Testimony and Phone DEPO Refer to Rules (as per my suggestion don’t change old fee schedule on these two)
Many Medical Biller’s and medical billing companies don’t know about this update go ahead and ask them about this update. Some doctors are happy with their current medical billers because biller just shows the things which they want to show medical doctor and medical providers are too busy to check data of reimbursement and open items.
Most of the time medical biller’s are unable to reach any worker comp case manager or Customer care department and they keep leaving voicemails and notes into the system, this leads to nowhere, old claims still sitting down in system for years and eventually they adjust/write-off the claims after 2 years and medical doctor don’t even know about these loss. I can understand that there are few Govt. carrier are really tough to deal with, I can show you many examples. To deal with these Govt. carriers there are many easy ways to reach them and get claims paid in no time, but people are not creative any more they just want to finish the work and go home, that’s it.
After this new fee schedule, I guess medical provider should not lose more money because this new fee schedule is equivalent to Commercial fee schedule.
I hope this information would help many medical doctors to improve cash flow and may increase revenue after 04/01/2019 would very help full for all people in the Healthcare industry especially in New York. One more important thing, This new fee schedule is also applicable on No-fault claims.
And Please, don’t criticize this article just send feedback and ask any question if you may have I will try to resolve everything you ask, send me email or drop me a message in the box.
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Blog Written By: Raman
My Email: Raman@monarchrcm.com
Credit: http://www.wcb.ny.gov and https://www.optum360.com/