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The New York State Workers' Compensation Board Increases Reimbursement Rates for Emergency Room Services for the First Time Since 1995

On May 1, 2019, the New York State Workers’ Compensation Board (“WCB”) adopted amendments to Subpart 329-3 of 12 NYCRR, updating and establishing fees for emergency room (“ER”) services, rural area outpatient clinics, hospital-based mental health clinics, and private psychiatric hospitals. The amendments increase ER reimbursement rates that were last updated in 1995, and for the first time establish fees for both rural clinics and private psychiatric hospitals.

Beginning July 15, 2019, the new fee schedule rate for emergency room services will be one hundred fifty (150%) percent of the Department of Health’s Enhanced Ambulatory Patient Groups (“EAPG”) Base Rate Fees, which means that rates will fluctuate based on the quantity and type of services provided.

The New York State Department of Financial Services (“DFS”) has not passed an emergency regulation delaying the application of this new fee schedule rate to No-Fault (i.e. to treatment rendered to automobile accident victims). As such, these updated and newly established rates will affect all treatment rendered to No-Fault patients on or after July 15, 2019.

The Firm encourages its clients to speak directly with their billing and coding professionals to obtain a more in depth understanding of the services which will be impacted by these amendments.

The full text of the amendment can be found on the WCB’s website via the following link: http://www.wcb.ny.gov/content/main/wclaws/Subpart_329_3ERandClinic/Subpart_329_3ERandClinic.jsp. The amendment’s effective date can be found on the WCB’s website via the following link: http://www.wcb.ny.gov/content/main/SubjectNos/sn046_1175.jsp.