The following information has been received from Aetna to assist in your transition to the new program.

Please know NYSCA has heard the profession’s voice. We are as concerned as you are and are actively advocating for necessary changes.  Of particular concern are the chiropractic conversion factor, the 180-day wording, and impact on specialty practices.

Please be aware that after initial public comment period, the Workers Compensation Board (WCB) has produced a revised proposed fee schedule. There are comments available for review on the State Register and the fee schedule is available for review on the WCB website. 

Having reviewed public comments on the proposed medical fee schedule released in June (below), the New York State Workers' Compensation Board will be issuing a revised draft of the schedule on October 3, which will be followed by a 30-day public comment period. Following the public comment period, the Board will review all comments. When final regulations are adopted, the Board will announce an effective date for the new schedule. Please watch for more information.

As you may recall, the NYS WCB proposed a much needed update to the fee schedule. On behalf of the profession the NYSCA and Council responded with formal public comments on the proposed WC fee schedule.

Members of the NYSCA insurance committee met with Aetna and NIA to discuss the implementation of the new Pre-Authorization Program which went into effect on 09/01/18.  We understand that many of you were not notified until late July / early August and could not attend NIA's webinar on August 7, 9 or 16.  There has been some confusion regarding different aspects of the program, resulting in our reaching out to Aetna to discuss your concerns.

It’s that time of year again. As you may be aware, every year since its inception, there have been updates to ICD-10 codes. Some years have more changes, others fewer. As of October 1, 2018 the following changes will go into effect:

Note from the NYSCA Insurance Committee:

Please note the following update relative to Aetna's new Prior Authorization Program which went into effect 9/1/18.

As of 09/07/2018 Special Funds Conservation Committee has officially closed down operation. Each patient that was assigned to Special Funds will revert back to the original carrier they had prior to special funds or NCA (Neuman claims administrator).  Many patients were notified of this by their designated carrier.

Please note that the WCB has updated a few common forms including the MG-2 and MG-2.1. They have been revised to include a place for providers to include their National Provider Information (NPI) number.

Please note that CMS implemented a new rule to requires doctors of chiropractic to add a 2nd modifier when billing Medicare for non-covered physical medicine services.

Medicare’s Merit-based Incentive Payment System (MIPS) Final Rule increased the threshold for participation. With this increase, a significant number of providers fall into the exempt category and they are now breathing a sigh of relief. However, there’s one hidden tidbit which you may have missed - the potential damage to your reputation and practice if you DO NOT participate. As incredulous as this may sound, it’s a possibility to consider as your scores will be published on the Physician Compare website for all the world to see. Those scores may also be used for other third-party physician rating websites. One study found that 65% of people are aware of these rating sites and many use them regularly. Providers with high scores have an advantage over their competitors. Damage to online reputations could take years to undo.

The Workers’ Compensation Board has finalized the new Schedule Loss of Use Impairment Guidelines after consideration of much input from a variety of stake holders, including health care professionals.