Workers comp board revises ambulatory surgery fee schedule
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The New York State Workers' Compensation Board has adopted a new ambulatory surgery fee schedule despite requests to reconsider certain rate reductions or delay the transition.
The board has changed the methodology for reimbursement of fees for ambulatory surgery effective Dec. 30, 2015, according to a notice of rulemaking activities.
During the public comment period that began on Sept. 16 and expired on Oct. 26, the New York State Association of Ambulatory Surgery Centers asked the board to reconsider cuts to pain management reimbursement. However, the board disputed that these rates have been reduced, according to the notice.
“While Medicaid and Medicare may have cut some base rates associated to pain management reimbursement, the Ambulatory Fee Schedule reimburses at 150% of Medicaid,” the notice stated.
The centers also argued that the fee schedule reduced rates for orthopedic surgeons' reimbursements, which would result in more patients having surgeries performed in hospitals at increased costs to the system. But the board denied the fee schedule reduced reimbursement to orthopedic surgeons.
The centers also stated that the board's transition to ICD-10 — the latest version of the International Statistical Classification of Diseases and Related Health Problems coding system — from ICD-9 imposed a hardship on its members because the payer community was not prepared, a comment rejected by the board because it announced the transition to ICD-10 in 2012.
The board also rebuffed comments from providers of spinal cord stimulators that its new methodology does not permit separate reimbursement for the stimulators, which reduces payments for the devices, according to the notice. The methodology incorporates payment for the implant within the total cost for the procedure in a manner consistent with Medicaid and other health plans' approach, among other factors cited by the board in rejecting those comments.
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