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NEWSLETTERS
Message from NYS Bones President... Lorraine C Woods FACMPE
On Monday November 14, 2011 I and a number of other provider groups and Heather Bennett from NYSSOS attended a meeting with the NYS Workers Compensation Board to discuss the current NYS Guidelines.
I wanted to give you a brief update on highlights from the meeting... and I am looking for your input into a number of questions/ issues that were raised.
Agenda Points
PT treatment discussion re whether it might be more beneficial and easier for all to calculate if the authorizations were based on visits instead of modalities.
WCB Form Letter EC-75 the board indicated they are approving about 20% of submissions. Many denials were result of incomplete information in many instances basic information such as case number and other identifying information. The Board is looking to set up training sessions to be sure providers and staff understand how to correctly and completely fill out the necessary information. The board admits that the time for their decision is volume driven and there have been times there have been delays.
It is important to note that the insurance companies do not have an appeal right in these decisions. EXCEPT if they dispute that they received the request on the date specified. There have been a number of instances where the board has reversed their decision based on these discrepancies. If the carrier disputes the decision- provider must wait for the board to send EC325 which will either affirm or reverse the original order of the chair. Board estimated less than 5% have been overturned.
If any practice has had issues with this- please send me details.
Request for Review MG2- denial. There are two venues 1] medical director paper based, quicker turnaround and 2] medical arbiter process. In order to use the medical director process all parties including the carrier must agree .
Major issue brought up by the board the date the physician signs/certifies the information for review MUST BE THE SAME DATE THE FORM IS FAXED/RECEIVED BY THE BOARD. If these dates are not the same will lead to technical denials.
After discussion the board will review statute to see if they can restate so physician can sign and staff can certify and fax.
Again the board indicated that these instructions do appear on the website but are looking at webinars and detailed written instructions to assist in the correct completion of these forms.
Be aware of dates and be sure that fax date and date certified/ signed are the same.
Forms Board is looking to revise the forms and will submit for comment.
Diagnostic Test Auth- On or about 11/24/11 the board is going to present new regs and updates for 30 day comment period. Among some of the changes
o Adding carpal tunnel
o Carrier must advise prior to treatment if they require use of radiology network
o Possible new reg that on initial visit plain film can be done at treating provider office especially for fracture care.
Submission of multiple MG2s on same treatment one major issue the board and carriers have is with groups that send more than one MG2 for same treatment/ same time period. Per the board additional MG2s can create confusion and if filled out differently may result in different decision outcomes.
Medical Treatment Guideline Navigation Tools board asked if anyone was using program developed by the Reed Group. I indicated that NYS Bones was having a session on Tuesday Nov 15th to present to membership and would report feedback to the board. Heather Bennetr reiterated that NYSSOS had purchased enterprise license for members that would be good thru May of 2012.
This was a very brief overview of the discussion that occurred yesterday. If you have feedback you would like me to bring to the boards attention, please let me know. It is the intention of the board to have another meeting early in 2012 in particular to review the C4 family of forms.
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4th Annual Conference Update from Our President
September 17, 2011
An Introduction to NYS Bones and an Overview of their 4th Annual Conference
Lorraine C Woods FACMPE President NYS Bones
As the new President of NYS Bones I would like to take this opportunity to introduce you to the association whose mission is to promote the professional development of the orthopedic manager through peer interaction and group educational programs. I have just returned from our 4th Annual Conference and I wanted to give you a brief overview of the topics that were covered.
On a rainy Thursday afternoon in September a group of orthopedic practice administrators and managers gathered at the Desmond Hotel in Albany.
The opening speaker, a former Marine Corps Sergeant and fifteen year veteran of the fire service gave a spirited talk outlining the leadership principles perfected by the Marine Corp. While many in the audience were familiar with the ideas of defining mission and objectives, many learned some new perspectives on the benefits of limiting their scope of control. The marines, at all levels, limit this scope to the magic number of three. Jason Ferris gave concrete examples of how this might be accomplished in a physician office without increasing salaries or the number of FTEs.
Cindy Dunn gave an insightful session on the newest hot topic Meaningful Use. She was able to give detailed information on the type of data that an orthopedic office would be required to capture and report on in order to qualify for this federal money. While not advocating one EMR over another, Cindy was able to give the audience guidance re questions or concerns that need to be addressed by our vendors in order to assure their readiness for meaningful use.
Cass Schaedig from Trellis Healthcare gave an informative talk on how practice productivity could be evaluated and benchmarked using RVUs. Additionally she presented ideas on how to use some free software that would assist in marketing efforts and suggestions on ways to effectively compare fee schedules across different carriers. She left the attendees with access to a URL where we could input our own practice data and produce some benchmark reports that could be used to present this information to the physicians in our respective practices.
One of the more interesting sessions was the Ultrasound Panel Discussion. Here representatives from Sonosite, an ultrasound vendor and Medical Management Corporation, an orthopedic billing company teamed up with Dr. Shatynski from Capital Region Orthopedic Group to give a detailed demonstration of the various uses of ultrasound as both a diagnostic as well as used in needle guidance for intra-articular and tendon sheath injections. It is not too often attendees have the opportunity to see a vendor strip to his undershirt while the physician demonstrates how to visualize rotator cuff and labral tears!
In addition to these education sessions, the attendees have an opportunity to network with their peers to discuss problems and issues that are common to the orthopedic community. Two timely discussions involved how and when to notify employees under the new transparency rules for 401K plans as well as some innovative ways to decrease healthcare premiums without current benefit levels.
NYS Bones is fortunate to be well supported by numerous vendors which help to subsidize the cost of conference admission. This year companies like Genzyme, Breg, and SRSsoft were among the 20 plus vendors in the exhibit hall.
Did your practice administrator or office manager attend this event? If so I would bet they came back with at least one idea that more than paid for their attendance.
If they did not attend- pencil in our conference next fall. If your managers are not yet members of this organization- I would invite them to join.
Our next event will be a telephonic Lunch & Learn presentation. It will be held in November and will be a demonstration of the new online NY Medical Treatment Guidelines Navigation Application. The NYSSOS has worked with the Reed Group and arranged that this software is available to NYSSOS members at no cost for one year. Visit our website at www.nysbones.org for more information. If you treat workers comp patients and are struggling with use of the current guidelines, I invite you to have your staff attend this hour long presentation.
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