Compensation for Injured and Illness at Work
Treating patients in the NYS workers’ compensation system thanks to the recent increases to medical fee schedules and adoption of the CMS-1500 universal medical billing form, more in line with conventional health care now. Nevertheless, some differences remain in the treatment of such patients.
There are three important elements that medical professionals should include in every report treating a patient who has been injured or ill in the workplace. Note them because they help to get all the payments on time.
1. CAUSALITY: Providers must state what happened on the work that caused their patient injury or illness, as well as their opinion on whether this patient was injured in the workplace or while performing job-related duties.
2. WORK STATUS: Providers must specify where the patient currently works, even if it is not that job where the injury or illness occurred.
3. TEMPORARY VIOLATION: Providers must indicate the degree of temporary impairment due to a work-related injury or illness in percentages (0-100%), also known as the degree of disability.
The NYS Workers’ Compensation Board developed an easy-to-use medical description template that includes fields for each element to help treating physicians figure it out. This template should go together with CMS-1500 and notes about treatment. All providers are advised to attach this template to their records as their own notes may not have a place for these three critical elements. You can download it here https://www.wcb.ny.gov/CMS-1500/Medical_Report_Template.pdf. But in case you do decide to use your own template or electronic medical record, do not forget that the detailed elements should be located at the top of your medical description. If these three elements are not placed prominently, unfortunately, the treatment notes will not meet the wage loss compensation threshold, and the provider probably will not get his payout either.
For additional information and resources for providers, please visit the Provider page of the Board’s website http://www.wcb.ny.gov/. If you have questions, contact the Board’s Medical Director’s Office by email at WCBMedicalDirectorsOffice@wcb.ny.gov or by phone at 800-781-2362. For details on the CMS-1500 form, please visit https://www.wcb.ny.gov/CMS-1500
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