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Proposed Rule Making for Charges for Professional Health Services

Rumors always abound on what action the State of New York would take to preserve the benefits available under PIP (No Fault), where other states have higher reimbursement rates that this state. The Department of Financial services has now answered this. Please note that this proposal is, in part, a reaction to complaints made years ago regarding the reimbursement being sought by New Jersey providers treating New York patients. The full extent of the impact of this Proposal is currently being reviewed by the Firm’s professional coder and it is expected that specifics on the what we believe to be “usual” procedures performed will be forthcoming by mid-December 2016.

Under the attached Proposal, reimbursement shall be made to out-of-state health care professionals and facilities at the highest region rate for New York State No Fault payable in New York for any New York State resident treating out of state for non-emergent care.

The State has carved out the following exceptions:

  • Emergency treatment, which will be deemed emergent for 120 hours post-accident to an out-of-state resident.
  • Non-emergent care, if the New York State resident is residing in said state for a minimum of fourteen days for reasons other than receiving the treatment in question. This is to cover Snow Birds or persons on extended absence from New York who require treatment.
  • With a maximum fee of the amount that the out of state provider would be legally permissible to charge in the state in question.

The Department expects comments, but please note that it has been our past experience that unless a Trade Association or Lobbying Group is making the case, it will not have an impact. The Firm has already raised MUA not being accepted by most, if not all, Article 28 Facilities in the downstate region. Regretfully, if the Chiropractic Association does not raise this issue, this track of inquiry will not go anywhere. It is clearly an unknown of whether a lobbyist not associated with an association should be employed by You. It is not expected that the Medical Society, The Article 28 Association, or hospital shall object to this change.

It does not appear to be a Proposal affecting past billing and it is suspected that this will have a starting date for either the service rendered or the billing of same if and when implemented.

This is merely a summary of what is believed to be the intentions and impact of the Proposal. Each client is advised to read the attached in detail and seek counsel on the issues raised herein.

Of course, The Horn Wright, LLP is available to discuss specifics with any client of the Firm. Please contact either Russell Friedman or Bruce Klein for further information.

Bad tidings are difficult to advise clients of, but The Firm believes that by providing the information, each client can plan to act accordingly if and when the change occurs.

Please follow the link above to read more information on the proposal.