Responses NY worker comp

Responses NY worker comp

Thanks for all the replies. I will share a few replies but this sums it up.
 Apparently there is a law in NY regarding workers comp allowable's. I was
getting correct info. NY work comp will pay either the NY medicaid
allowable, 50% over manufacturer invoice or U & C whatever is the lowest rate. What
is shocking to me is that there are people accepting 50% over invoice. Does
anyone have a link to the NY Medicaid fee schedule? I would appreciate that.
David Falk, LPO, CPO
 
NYS comp reimbursement rate was just tied to NYS Medicaid rate. As
explained to me at the NYSAAOP conference in Cooperstown, By Dr. Khan, that was
supposed to be a good thing. The reasoning was that if we had a pt. with an Rx
and there existed an L-code we would get paid and not have to go through such a
long approval process and negotiate a rate. Reality, you still need to get
approval and now we get paid the Medicaid rate as compared to our private
fee. Yes, that is a huge loss in revenue for us in NYS. It is quite
interesting that the working men/women in NYS who are in need of care now get the same
as the poor (Medicaid) , that probably have not ever held a job. This was
how the Governor lowered the Workmen's Comp insurance rate for businesses.
Gotta to love NYS
 
Any time I have a problem with the comp carriers I print out the NY Caid
fees and the AOPA picture book and fax them 20 pages and them point out the
below. If we don't all stick together THEY win. Many times they can find somebody
to do it cheaper, when they call me to shop prices I always tell them Mcaid
fees. hope this helped.
Good luck
Joe Schneemann,CO
All Island O & P

_ <URL Redacted>
oods_Fee_
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They want to use the Medicaid fee schedule now for items with codes.
Otherwise cost plus 50 %. It really sucks to be in NY. We should all tell
Medicaid to raise their fee schedule or do their own work. This would be the first
step at being reimbursed at a livable rate. For those who do not remember
or are too young, that fee schedule came out in 1976. We are still being
paid for base procedures at that level. Wake up !! Show me anyone else that
is being raped like that.
Section 442.2 Fee Schedule
The maximum permissible charge for the purchase of durable medical
equipment, medical/surgical supplies, orthopedic footwear and orthotic and prosthetic
appliances shall be the fee payable for such equipment or supplies under the
New York State Medicaid program at the time such equipment and supplies are
provided. If the New York State Medicaid program has not established a fee
payable for the specific item, then the fee payable, in accordance with Medicaid
 rules, shall be the lesser of:
· the acquisition cost (i.e. the line item cost from a manufacturer
or wholesaler net of any rebates, discounts or other valuable considerations,
mailing, shipping, handling, insurance costs or any sales tax) to the
provider plus 50%; or
· the usual and customary price charged to the general public.
The maximum permissible monthly rental charge for such equipment, supplies
and services provided on a rental basis shall not exceed the lower of the
monthly rental charge to the general public or the price determined by the New
York State Department of Health area office. The total accumulated monthly
rental charges shall not exceed the fee amount allowed under the Medicaid fee
schedule.




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