reglab/statecodes huggingface dataset:
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-8 - Preferred Provider Organization Arrangements › Section 325-8.5 - Improper influence or involvement in medical treatment

Current through Register Vol. 46, No. 28, July 10, 2024
(a) No person, including but not limited to
					 the employer, insurer, carrier, self-insured employer or any of their agents
					 shall interfere with the selection by an injured employee of an authorized
					 physician for treatment except as authorized by article 10-A, section 354  of
					 the Workers' Compensation Law nor shall any insurer, carrier or self-insured
					 employer improperly influence or attempt to improperly influence the medical
					 opinion of any physician who has treated or examined an injured employee within
					 the meaning of section 13-a (6)  of the Workers' Compensation Law.
(b) No insurer, carrier or self-insured
					 employer shall participate in the treatment of an injured employee within the
					 meaning of section 13-j (1)  of the Workers' Compensation Law.
(c) All functional activities which are
					 subcontracted by a PPO through a management contract arrangement in accordance
					 with section
					 732-2.5(b)
					 of Title 10 NYCRR, including case management services, as defined by the
					 parties to the management contract, shall conform to the provisions of section 13-a (6) and 13-j (1)  of the Workers' Compensation Law. Copies of all management
					 contracts shall be provided to the chair as well as the Commissioner of Health
					 for compliance purposes. Where necessary, the chair or the Commissioner of
					 Health shall seek additional information from insurers, carriers and
					 self-insured employers who enter into such arrangements with PPOs to ensure
					 compliance with this Part.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-8 - Preferred Provider Organization Arrangements › Section 325-8.6 - Applicability of board rules and regulations

Current through Register Vol. 46, No. 28, July 10, 2024
All rules and regulations of the chair and the board with
						respect to the rights, duties and obligations of employees, employers,
						insurance carriers, and authorized providers under the Workers' Compensation
						Law are expressly made applicable to preferred provider organization
						arrangements except to the extent that such rules and regulations are
						inconsistent with article 10-A of the Workers' Compensation Law or the rules
						and regulations promulgated pursuant to article 10-A of the Workers'
						Compensation Law.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 326 - Medical Appeals Unit Rules Relating To The Practice Of Medicine › Subpart 326-1 - Procedure Before County Medical Societies And Workers' Compensation Committees Thereof › Section 326-1.1 - Application for authority to render medical care or for rerating

Current through Register Vol. 46, No. 28, July 10, 2024
Application of a duly licensed physician of the State of
						New York for authority to render medical care under the Workers' Compensation
						Law or for rerating thereunder, shall be made upon the application form
						prescribed for that purpose by the chair and shall be filed with the county
						medical society, or with the workers' compensation committee of the county
						medical society, of the county in which his office is located, except that in
						the case of a licensed physician with a degree of doctor of osteopathic
						medicine, such application may be filed with the appropriate county medical
						society or with the New York State Osteopathic Medical Society, Inc. The chair
						will notify the physician of approval or nonapproval of his or her application
						within 60 days after receipt by the board of the recommendation by the medical
						society, workers' compensation committee of the county medical society, or in
						the case of a licensed physician with a degree of doctor of osteopathic
						medicine, by the appropriate county medical society or the New York State
						Osteopathic Medical Society, Inc.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 326 - Medical Appeals Unit Rules Relating To The Practice Of Medicine › Subpart 326-1 - Procedure Before County Medical Societies And Workers' Compensation Committees Thereof › Section 326-1.2 - Application for license to operate medical bureau or laboratory

Current through Register Vol. 46, No. 28, July 10, 2024
Applications for licenses to operate compensation medical
						bureaus or laboratories and for other laboratories and bureaus shall be made
						upon the application form prescribed for the purpose by the chair and shall be
						filed with the county medical society, or the workers' compensation committee
						of the county medical society, of the county in which such medical bureau or
						laboratory is located.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 326 - Medical Appeals Unit Rules Relating To The Practice Of Medicine › Subpart 326-1 - Procedure Before County Medical Societies And Workers' Compensation Committees Thereof › Section 326-1.3 - Investigation of application

Current through Register Vol. 46, No. 28, July 10, 2024
The county medical society or the workers' compensation
						committee of the county medical society, as the case may be, shall investigate
						and pass upon the application within 60 days of such filing.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 326 - Medical Appeals Unit Rules Relating To The Practice Of Medicine › Subpart 326-1 - Procedure Before County Medical Societies And Workers' Compensation Committees Thereof › Section 326-1.4 - Notification to applicant of nonapproval

Current through Register Vol. 46, No. 28, July 10, 2024
If the county medical society or the workers'
						compensation committee of the county medical society, as the case may be, shall
						fail to recommend approval of any such application, whether for authority to
						render medical care, or for rerating, or for a medical bureau or laboratory, or
						other laboratory or bureau, it shall promptly notify the applicant thereof in
						writing. The applicant may, within 30 days from the date such notice was
						mailed, appeal in writing to the Medical Appeals Unit.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 326 - Medical Appeals Unit Rules Relating To The Practice Of Medicine › Subpart 326-1 - Procedure Before County Medical Societies And Workers' Compensation Committees Thereof › Section 326-1.5 - Investigation and hearing procedure

Current through Register Vol. 46, No. 28, July 10, 2024
In any investigation or hearing conducted pursuant to the
						Workers' Compensation Law before the county medical society, or the workers'
						compensation committee of a county medical society, pertaining to the
						revocation or suspension of the authority of any physician or the revocation of
						the license for a compensation medical bureau or laboratory, the following
						rules of procedure shall apply:
(a)
					 The accused physician, medical bureau or laboratory shall be given 30 days'
					 notice in writing, containing a brief statement of the charge or charges
					 against such physician, medical bureau or laboratory, and the time when and the
					 place where such charge or charges will be heard. Such notice shall be served
					 either personally or by mail. At least 10 days prior to the hearing date fixed
					 in said notice, the accused physician, medical bureau or laboratory shall file
					 an answer to such charges with the county medical society or the workers'
					 compensation committee of a county medical society, as the case may
					 be.
(b) At the hearing on such
					 charge or charges, the accused physician, medical bureau or laboratory shall be
					 entitled to be represented by counsel and to cross-examine witnesses. A
					 verbatim record of the proceeding shall be made, and witnesses shall testify
					 under oath.
(c) A copy of the
					 record of the proceeding shall be submitted to the chair together with the
					 report, findings and recommendation of the county medical society or of the
					 workers' compensation committee of a county medical society, as the case may
					 be.
(d) Simultaneously, the county
					 medical society, or the workers' compensation committee of a county medical
					 society, which heard such charge or charges, shall serve personally or by mail
					 a copy of its report, findings and recommendation on the accused physician,
					 medical bureau or laboratory.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 326 - Medical Appeals Unit Rules Relating To The Practice Of Medicine › Subpart 326-1 - Procedure Before County Medical Societies And Workers' Compensation Committees Thereof › Section 326-1.6 - Content of notice of appeal

Current through Register Vol. 46, No. 28, July 10, 2024
The notice of appeal, or request for review (these terms
						being used synonymously), shall state the reasons on which the appeal is
						taken.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 326 - Medical Appeals Unit Rules Relating To The Practice Of Medicine › Subpart 326-1 - Procedure Before County Medical Societies And Workers' Compensation Committees Thereof › Section 326-1.7 - Conduct of hearing

Current through Register Vol. 46, No. 28, July 10, 2024
The county medical society, or the workers' compensation
						committee of a county medical society, in the conduct of a hearing shall not be
						bound by common law or statutory rules of evidence, or by technical or formal
						rules of procedure, except as provided herein; and may make such investigation
						or inquiry and conduct such hearing in the manner it deems advisable and
						necessary.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 326 - Medical Appeals Unit Rules Relating To The Practice Of Medicine › Subpart 326-1 - Procedure Before County Medical Societies And Workers' Compensation Committees Thereof › Section 326-1.8 - Application of terms

Current through Register Vol. 46, No. 28, July 10, 2024
Whenever in this Part reference is made to a county
						medical society, it shall, in the case of a licensed physician of any other
						school of medical practice, be construed to mean the board representing such
						other school of medical practice. In the case of a physician who is licensed as
						an osteopath, the "board" may be either the appropriate county medical society
						or the New York State Osteopathic Society, Inc.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 326 - Medical Appeals Unit Rules Relating To The Practice Of Medicine › Subpart 326-2 - Procedure Governing Appeals And Reviews Before The Medical Appeals Unit › Section 326-2.1 - Acknowledgment of notice of appeal

Current through Register Vol. 46, No. 28, July 10, 2024
Upon receipt of notice of appeal or an application for
						review, the secretary of the Medical Appeals Unit shall promptly acknowledge
						receipt thereof by letter to the appellant and his attorney.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 326 - Medical Appeals Unit Rules Relating To The Practice Of Medicine › Subpart 326-2 - Procedure Governing Appeals And Reviews Before The Medical Appeals Unit › Section 326-2.2 - Service of notice of appeal

Current through Register Vol. 46, No. 28, July 10, 2024
Within 30 days after service of a copy of the report,
						findings and recommendation of the county medical society, or of the workers'
						compensation committee of the county medical society, the accused physician,
						medical bureau or laboratory may appeal therefrom to the Medical Appeals Unit
						by serving written notice of appeal, personally or by mail, upon the secretary
						of the Medical Appeals Unit, 100 Broadway-Menands, Albany, NY 12241, and also
						upon the county medical society or the workers' compensation committee of the
						county medical society, whichever made the report, findings and recommendation
						from which appeal is taken.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 326 - Medical Appeals Unit Rules Relating To The Practice Of Medicine › Subpart 326-2 - Procedure Governing Appeals And Reviews Before The Medical Appeals Unit › Section 326-2.3 - Content of notice of appeal

Current through Register Vol. 46, No. 28, July 10, 2024
The notice of appeal or request for review (these terms
						being used synonymously) shall state the reasons on which the appeal is
						taken.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 326 - Medical Appeals Unit Rules Relating To The Practice Of Medicine › Subpart 326-2 - Procedure Governing Appeals And Reviews Before The Medical Appeals Unit › Section 326-2.4 - Basis of medical appeals unit's decision

Current through Register Vol. 46, No. 28, July 10, 2024
Upon the record of the county medical society, or the
						workers' compensation committee of a county medical society, and on such briefs
						as the appellant may submit, the Medical Appeals Unit may affirm, reverse or
						modify the report, findings and recommendation of the county medical society,
						or of the workers' compensation committee of a county medical society, appealed
						or reviewed.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 326 - Medical Appeals Unit Rules Relating To The Practice Of Medicine › Subpart 326-2 - Procedure Governing Appeals And Reviews Before The Medical Appeals Unit › Section 326-2.5 - Oral argument, additional evidence discretionary

Current through Register Vol. 46, No. 28, July 10, 2024
In furtherance of justice and in its sole discretion, the
						Medical Appeals Unit may permit oral argument or receive additional evidence
						and testimony.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 326 - Medical Appeals Unit Rules Relating To The Practice Of Medicine › Subpart 326-2 - Procedure Governing Appeals And Reviews Before The Medical Appeals Unit › Section 326-2.6 - Notice of oral argument, additional testimony

Current through Register Vol. 46, No. 28, July 10, 2024
Where oral argument or the taking of additional testimony
						is permitted, the Medical Appeals Unit shall fix a time and place for such
						argument or for the taking of testimony, and notice thereof shall be given by
						mail to the appellant, or appellant's attorney if there is noted the appearance
						by an attorney, and to the county medical society or the workers' compensation
						committee of a county medical society, as the case may be, from the findings
						and recommendation on which the appeal was taken.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 326 - Medical Appeals Unit Rules Relating To The Practice Of Medicine › Subpart 326-2 - Procedure Governing Appeals And Reviews Before The Medical Appeals Unit › Section 326-2.7 - Hearing of oral argument, additional testimony

Current through Register Vol. 46, No. 28, July 10, 2024
If the Medical Appeals Unit shall permit oral argument or
						the taking of additional testimony, any one or more than one of the members of
						the Medical Appeals Unit may conduct the hearing. A verbatim record of such
						oral argument, testimony and evidence shall be made and filed with and become
						part of the record of the case on appeal or review, and thereupon the Medical
						Appeals Unit shall make its decision and recommendation
						thereon.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 326 - Medical Appeals Unit Rules Relating To The Practice Of Medicine › Subpart 326-2 - Procedure Governing Appeals And Reviews Before The Medical Appeals Unit › Section 326-2.8 - Conduct of hearing

Current through Register Vol. 46, No. 28, July 10, 2024
The Medical Appeals Unit, in the conduct of a hearing,
						shall not be bound by common law or statutory rules of evidence, or by
						technical or formal rules of procedure, except as provided herein; and may make
						such investigation or inquiry and conduct such hearing in the manner it deems
						advisable and necessary.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 326 - Medical Appeals Unit Rules Relating To The Practice Of Medicine › Subpart 326-2 - Procedure Governing Appeals And Reviews Before The Medical Appeals Unit › Section 326-2.9 - Decision

Current through Register Vol. 46, No. 28, July 10, 2024
A decision concurred in by two of the three members of
						the Medical Appeals Unit shall constitute the decision of the Medical Appeals
						Unit.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 326 - Medical Appeals Unit Rules Relating To The Practice Of Medicine › Subpart 326-2 - Procedure Governing Appeals And Reviews Before The Medical Appeals Unit › Section 326-2.10 - Continuation of medical practice during proceedings

Current through Register Vol. 46, No. 28, July 10, 2024
Until final action is taken by the chair on the findings
						and recommendations of the county medical society, or the workers' compensation
						committee of a county medical society, or the Medical Appeals Unit, the accused
						physician, medical bureau or laboratory may continue in the practice of his or
						her profession or the conduct of said bureau or laboratory under the Workers'
						Compensation Law, unless otherwise specifically ordered by the
						chair.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 327 - ARBITRATION OF HOSPITAL BILLS › Section 327.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Chair shall
				  mean the chairman, chairwoman or chair of the Workers' Compensation Board of
				  the State of New York.
(b) Carrier
				  shall mean an employer or its workers' compensation insurance carrier, if
				  insured.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 327 - ARBITRATION OF HOSPITAL BILLS › Section 327.2 - Notice of carrier's objection to bill and hospital's request for arbitration of bills for services rendered prior to october 1, 1994

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Notice of objection by a carrier to any
				  bill for hospital care (herein referred to as a hospital bill) or for services
				  performed by a hospital shall be given to the chair in duplicate and two copies
				  to the hospital whose bill is in dispute within 30 days after such bill has
				  been rendered, notice of objection to be in the form (A-1) prescribed by the
				  chair for that purpose. The notice shall briefly state all of the carrier's
				  objections to the bill. Where compensability of the claim is controverted and
				  has not yet been determined, or where other issues requiring Workers'
				  Compensation Board determination are interposed as reasons for nonpayment of
				  the bill, the notice of objection shall so state.
(b) Upon receipt of such notice of objection
				  (A-1), the hospital may request arbitration by notifying the chair in
				  accordance with the following:
(1) if only
				  arbitration issues are raised, the request for arbitration shall be made within
				  60 days after receipt of the notice of objection (A-1);
(2) if there are issues requiring
				  adjudication by a Workers' Compensation Law judge in addition to arbitration
				  issues, the request for arbitration shall be made within 60 days of the filing
				  of the decision in favor of the hospital; and
(3) failure to make timely request for
				  arbitration shall be deemed a waiver of the right to arbitration.
If the hospital wishes to arbitrate the bill, it shall
					 complete and sign the request form for arbitration and forward it to the
					 medical registration section together with a check to the order of the Chair,
					 Workers' Compensation Board, in the sum of $5 as a minimum arbitration fee.
					 Notwithstanding any provision in this section to the contrary, upon application
					 of the hospital, the chair may for good cause shown excuse the hospital for the
					 delay in filing the request for arbitration, and schedule the disputed bill for
					 arbitration.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 327 - ARBITRATION OF HOSPITAL BILLS › Section 327.4 - Date of hearing

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The chair
				  shall from time to time prepare calendars of disputed bills (other than those
				  in which compensability has not yet been established) and shall arrange the
				  time and place of hearings.
(b) The
				  chair, at least 30 days prior to the date set for any hearing, shall mail
				  notice of the hearing, stating the time and place thereof, to the carrier and
				  to the hospital which rendered the bill.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 327 - ARBITRATION OF HOSPITAL BILLS › Section 327.5 - Withdrawal of objection; settlement

Current through Register Vol. 46, No. 28, July 10, 2024
(a) At any time not later than the 10th day
				  prior to the date set for a hearing, the carrier may file with the chair a
				  withdrawal of objection to a disputed hospital bill for services rendered prior
				  to October 1, 1994 in the form (A-3) prescribed by the chair for that purpose,
				  in which event the chair shall refund to the hospital the $5 arbitration fee
				  paid. If the parties settle their dispute after the 10th day prior to the date
				  set for hearing, notice of settlement in the form (A-4) prescribed by the chair
				  for that purpose shall be signed by all parties and filed with the chair on or
				  before the date set for the hearing. The parties to such a settlement shall
				  each pay to the chair a minimum arbitration fee of $5 in the manner provided in
				  section
				  327.9 
				  of this Part. Notwithstanding the foregoing, withdrawal of objection to, and
				  settlement of, disputed hospital bills for services rendered on or after
				  October 1, 1994 shall be subject to subdivision (b) of this section.
(b) The carrier may file with the chair on a
				  form (HP-4) prescribed by the chair a notice of withdrawal of its explanation
				  for nonpayment of a hospital's bill for services rendered on or after October
				  1, 1994 at any time not later than the 30th day prior to the date set for a
				  hearing; provided, however, that if such form is received by the chair less
				  than 30 days prior to the date set for a hearing the carrier shall pay to the
				  chair a minimum arbitration fee of $5 in the manner provided in section
				  327.9 
				  of this Part. If the parties settle their dispute prior to the date set for
				  hearing, notice of settlement on the form (HP-4) prescribed by the chair for
				  that purpose shall be signed by all parties and filed with the chair on or
				  before the date set for the hearing. The parties to such a settlement shall
				  each pay to the chair a minimum arbitration fee of $5 in the manner provided in
				  section
				  327.9 
				  of this Part.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 327 - ARBITRATION OF HOSPITAL BILLS › Section 327.6 - Conduct of hearing

Current through Register Vol. 46, No. 28, July 10, 2024
The hospital arbitration committee shall not be bound by
					 common law or statutory rules of evidence or by technical or formal rules of
					 procedure, but may make such investigation or inquiry and conduct its hearings
					 in such manner as it deems proper and necessary in the
					 premises.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 327 - ARBITRATION OF HOSPITAL BILLS › Section 327.7 - Decision

Current through Register Vol. 46, No. 28, July 10, 2024
The decision of two members of the hospital arbitration
					 committee shall constitute the decision of the committee and shall be binding
					 upon the parties; and if only two members are present at the time and place of
					 hearing, their joint decision shall constitute the decision of the
					 committee.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 327 - ARBITRATION OF HOSPITAL BILLS › Section 327.8 - Signing, filing of decision

Current through Register Vol. 46, No. 28, July 10, 2024
The decision shall be signed by the members of the hospital
					 arbitration committee making the decision and shall be filed with the secretary
					 of the board, and notice of the decision shall be mailed to the hospital and to
					 the carrier.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 327 - ARBITRATION OF HOSPITAL BILLS › Section 327.9 - Payment of fees and award

Current through Register Vol. 46, No. 28, July 10, 2024
Additional statutory authority: Workers' Compensation Law,
					 13-a(3), 13-k
(a) Each of the parties
				  to every disputed hospital bill shall pay to the chair five per centum of the
				  amount payable under the decision of the hospital arbitration committee or the
				  sum of $5, whichever is greater. If there is no amount payable under such
				  decision, or if the disputed bill is determined by notice of settlement, each
				  party to the proceeding shall pay to the chair a minimum arbitration fee of $5.
				  If the carrier files a notice of withdrawal of its explanation for nonpayment
				  of a bill for services rendered on or after October 1, 1994 prior to the date
				  set for the hearing and such notice is received by the chair less than 30 days
				  prior to such date, the carrier shall pay to the chair a minimum arbitration
				  fee of $5. All sums collected by the chair hereunder shall be transferred to
				  the State treasury as reimbursement on account of the expenses of
				  administration.
(b) Payment
				  pursuant to a decision of the hospital arbitration committee, including a
				  decision pursuant to notice of settlement, shall be made as follows:
(1) If the amount of the bill awarded by
				  decision (other than pursuant to notice of settlement), is more than $100, the
				  carrier shall promptly:
(i) pay to the
				  hospital the amount directed in the decision, less the balance of the expense
				  fee of five per centum due from the hospital;
(ii) pay to the chair an expense fee due from
				  the carrier of five per centum of the amount directed in the award and
				  decision, plus the balance of the expense fee due from the hospital and to be
				  deducted pursuant to subparagraph (i) of this paragraph; provided, however,
				  that for arbitration decisions on disputed bills for services rendered on or
				  after October 1, 1994, the amounts payable to the chair as expense fees shall
				  be billed to the carrier and collected by the board.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 327 - ARBITRATION OF HOSPITAL BILLS › Section 327.10 - Selection of arbitration committee

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In accordance with subdivision (3) of
				  section 13-g  of the Workers' Compensation Law, a hospital arbitration committee
				  shall consist of three physicians appointed by the chair. One such physician
				  may be nominated to the chair by the president of the Healthcare Association of
				  New York State and one physician may be nominated to the chair by the
				  carrier.
(b) To facilitate and
				  expedite the designation of arbitrators, when needed, separate panels of
				  prospective nominees may be periodically filed with the chair by the president
				  of the Healthcare Association of New York State and by or on behalf of carriers
				  generally. The nominators shall specify the districts of the board in which the
				  prospective nominees reside. Such filing shall be by letter mailed to the
				  chair. Names may be added or deleted from the panel from time to time, but no
				  deletion shall affect the appointment of any physician to a hospital
				  arbitration committee before written request for such deletion has been
				  received by the chair.
(c) A
				  nominee shall not be eligible to serve as an arbitrator with relation to any
				  bill rendered by a hospital or disputed by a carrier with whom he or she is in
				  any way associated.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 327 - ARBITRATION OF HOSPITAL BILLS › Section 327.11 - Entire bill to be arbitrated

Current through Register Vol. 46, No. 28, July 10, 2024
The entire bill of a hospital, including items of medical
					 care contained therein, shall be arbitrated by the hospital arbitration
					 committee. Items of medical care are subject to the medical fee
					 schedule.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 327 - ARBITRATION OF HOSPITAL BILLS › Section 327.12 - Chair of the committee; secretary of committee

Current through Register Vol. 46, No. 28, July 10, 2024
The chair shall appoint one member of a hospital
					 arbitration committee to serve as chair of the committee and shall also appoint
					 a secretary to such committee.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 327 - ARBITRATION OF HOSPITAL BILLS › Section 327.13 - Filing of notices

Current through Register Vol. 46, No. 28, July 10, 2024
All notices required to be filed with the chair, pursuant
					 to this Part, shall be deemed filed when received at the address specified on
					 such forms as may be prescribed by the chair pursuant to this
					 Part.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 328 - Arbitration Of Medical Bills › Section 328.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Chairman refers
				  to the chairman of the Workers' Compensation Board of the State of New
				  York.
(b) Medical society refers to
				  the appropriate county medical society, unless the claimant's physician is an
				  osteopath, in which case medical society refers to either the appropriate
				  county medical society or the New York State Osteopathic Society,
				  Inc.
(c) Carrier refers to the
				  employer or his insurer.
(d) Rating
				  board refers to the New York Compensation Insurance Rating Board.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 328 - Arbitration Of Medical Bills › Section 328.2 - Notice of objection to bill

Current through Register Vol. 46, No. 28, July 10, 2024
Notice of objection by a carrier to any bill for medical
					 care shall be given to the chairman in duplicate, and two copies thereof given
					 to the physician whose bill is in dispute, within 30 days after such bill has
					 been rendered, on the form (A-1) prescribed by the chairman for that purpose.
					 The notice shall briefly state all of the carrier's objections to the bill.
					 Where compensability of the claim is controverted and has not yet been
					 determined, or where other issues requiring Workers' Compensation Board
					 determination are interposed as reasons for nonpayment of the bill, the notice
					 of objection shall so state.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 328 - Arbitration Of Medical Bills › Section 328.3 - Physician's decision regarding arbitration

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Upon receipt of such notice of objection
				  (form A-1), the physician may request arbitration by notifying the chairman in
				  accordance with the following:
(1) If only
				  arbitration issues are raised, the request for arbitration shall be made within
				  60 days after receipt of the notice of objection (A-1).
(2) If there are issues requiring
				  adjudication by a Workers' Compensation Law judge in addition to arbitration
				  issues, the request for arbitration shall be made within 60 days of the filing
				  of the decision in favor of the physician.
(3) Failure to make timely request for
				  arbitration shall be deemed a waiver of the right to arbitration.
If the physician wishes to arbitrate the bill, he shall
					 complete and sign the request for arbitration and forward it to the medical
					 registration section together with a check to the order of the Chairman,
					 Workers' Compensation Board, in the sum of five dollars as a minimum
					 arbitration fee. Notwithstanding any provision in this section to the contrary,
					 upon application of the physician, the chairman may for good cause shown excuse
					 the physician for the delay in filing the request for arbitration, and schedule
					 the disputed bill for arbitration.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 328 - Arbitration Of Medical Bills › Section 328.4 - Date of hearing

Current through Register Vol. 46, No. 28, July 10, 2024
The chairman shall, from time to time, prepare a calendar
					 of cases for arbitration and with the medical society and the rating board
					 shall arrange for the time and place of hearing.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 328 - Arbitration Of Medical Bills › Section 328.5 - Composition of arbitration committee

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In accordance with subdivision (2) of
				  section 13-g  of the Workers' Compensation Law, an arbitration committee shall
				  comprise one physician designated on behalf of the claimant physician by the
				  president of the medical society, one physician designated on behalf of the
				  carrier by the rating board and one physician designated by the chairman,
				  Workers' Compensation Board. The carrier may name an arbitrator of its own
				  selection in any particular case, the nomination to be made through the rating
				  board. The arbitrators designated by the rating board and the chairman,
				  Workers' Compensation Board, shall be members of the Medical Society of the
				  State of New York.
(b) The
				  arbitrator designated by the chairman, Workers' Compensation Board, shall serve
				  as chairman of the committee.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 328 - Arbitration Of Medical Bills › Section 328.6 - Notices of arbitrators and hearing

Current through Register Vol. 46, No. 28, July 10, 2024
The rating board shall notify the chairman, Workers'
					 Compensation Board, of the name of the arbitrator which it has selected, at
					 least eight days before the date of the hearing. The medical society shall
					 notify the chairman, Workers' Compensation Board, of the name of the arbitrator
					 selected by its president, at least eight days before the date of the hearing.
					 At least 30 days prior to the date set for hearing, notice thereof shall be
					 mailed to the physician and carrier, advising the date, time and place of
					 hearing.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 328 - Arbitration Of Medical Bills › Section 328.7 - Withdrawal of objection; settlement

Current through Register Vol. 46, No. 28, July 10, 2024
A carrier may file with the chairman, not later than the
					 10th day prior to the date set for hearing, a withdrawal of objection on a form
					 (A-3) prescribed by the chairman for that purpose, in which event the chairman
					 will refund to the physician the $5 arbitration fee paid by him. If the parties
					 to the dispute settle their differences within 10 days prior to the date set
					 for hearing, notice of settlement on a form (A-4) prescribed by the chairman
					 for that purpose shall be signed by all parties and filed with the chairman on
					 or before the date set for hearing. The parties to such a settlement shall each
					 pay to the chairman a minimum arbitration fee of $5 in the manner provided in
					 section
					 328.11 
					 of this Part.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 328 - Arbitration Of Medical Bills › Section 328.8 - Oaths, record of proceedings

Current through Register Vol. 46, No. 28, July 10, 2024
The arbitrators shall be required to take the oath of
					 office. The chairman, Workers' Compensation Board, shall appoint a recording
					 clerk, who is authorized to administer oaths under the Workers' Compensation
					 Law, who shall administer the oath, and make a record of the proceedings on the
					 prescribed form. The chairman, Workers' Compensation Board, shall also appoint
					 a secretary to the arbitration committee. A stenographic transcript of the
					 hearing shall not be required.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 328 - Arbitration Of Medical Bills › Section 328.9 - Conduct of hearing

Current through Register Vol. 46, No. 28, July 10, 2024
The arbitration committee shall not be bound by common law
					 or statutory rules of evidence or by technical or formal rules of procedure but
					 may make such investigation or inquiry and conduct its hearing in such manner
					 as it deems proper and necessary in the premises. The claimant physician may
					 present his case, call his witnesses, present his proofs and submit to
					 questions thereon. The defending carrier may present its defense, call its
					 witnesses, present its proofs and submit to questions thereon. The arbitration
					 committee may, in the event of nonappearance, decide the value of the disputed
					 medical bill on the basis of the evidence before it. The majority decision of
					 such a committee shall be conclusive upon the parties as to the value of the
					 services rendered.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 328 - Arbitration Of Medical Bills › Section 328.10 - Decision

Current through Register Vol. 46, No. 28, July 10, 2024
The decision or award shall be signed by the arbitrators,
					 and shall be filed with the chairman, Workers' Compensation Board. Notices of
					 award of the arbitrators shall be forwarded to the physician and carrier by the
					 secretary of the arbitration committee.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 328 - Arbitration Of Medical Bills › Section 328.11 - Payment of fees and award

Current through Register Vol. 46, No. 28, July 10, 2024
The parties to disputed medical bill proceedings shall each
					 pay to the chairman a sum equal to five per centum of the amount payable under
					 such decision or $5, whichever is greater. If there is no amount payable under
					 such decision or if the disputed bill is determined by notice of settlement
					 (A-4), each party to the proceeding shall pay to the chairman a minimum
					 arbitration fee of $5. The sums so collected shall be transferred to the State
					 treasury to reimburse it on account of the expense of administration. Payment
					 pursuant to the decision of the arbitration committee shall be made as
					 follows:
(a) If the amount of the bill
				  awarded under a decision other than a notice of settlement (A-4) is more than
				  $100, the carrier shall promptly:
(1) pay to
				  the physician the amount directed in the award and decision, less the balance
				  of the arbitration fee due from the physician;
(2) pay to the chairman an arbitration fee
				  due from the carrier of five per centum of the amount directed in the award and
				  decision plus the balance of the arbitration fee due from the physician and
				  deducted pursuant to paragraph (1) of this subdivision.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 328 - Arbitration Of Medical Bills › Section 328.12 - Filing of notices

Current through Register Vol. 46, No. 28, July 10, 2024
All notices required to be filed with the chairman pursuant
					 to this Part, shall be deemed filed when received by the chairman, Workers'
					 Compensation Board, 180 Livingston Street, Brooklyn, NY
					 11248.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 329 - Medical, Outpatient And Ambulatory Surgery Services Fee Schedules › Subpart 329-1 - Medical Fee Schedule › Section 329-1.1 - Applicability of schedule

Current through Register Vol. 46, No. 28, July 10, 2024
The fee schedule applicable to medical, physical therapy
						and occupational therapy services shall be the medical fee schedule in effect
						on the date on which the medical, physical therapy or occupational therapy
						services were rendered, regardless of the date of accident.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 329 - Medical, Outpatient And Ambulatory Surgery Services Fee Schedules › Subpart 329-1 - Medical Fee Schedule › Section 329-1.2 - Proration of scheduled unit fee

Current through Register Vol. 46, No. 28, July 10, 2024
When the schedule specifies a unit fee for a definite
						treatment and period of aftercare, and the patient is transferred from one to
						another physician, the employer (or carrier) is responsible for the amount
						stated in the schedule. If the concerned physicians agree upon amount of
						proration, they shall render separate bills accordingly; in the event of no
						agreement, the matter shall be settled by by an arbitration committee appointed
						pursuant to section 13-g  of the Workers' Compensation Law without cost to the
						contestants. When treatment is terminated by death before the expiration of the
						allowable period of aftercare, the appropriate fee shall apply without
						proration. When treatment is terminated by departure of the injured worker from
						New York State before the expiration of the allowable period of aftercare, the
						fee shall be the earned portion of the appropriate fee, having regard for the
						fact that generally the greater portion is earned at the time of operation or
						other procedure.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 329 - Medical, Outpatient And Ambulatory Surgery Services Fee Schedules › Subpart 329-1 - Medical Fee Schedule › Section 329-1.3 - Medical fee schedule; incorporation by reference

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The medical fee schedule for medical
					 services shall be the Official New York Workers' Compensation Medical Fee
					 Schedule, updated December 11, 2019, prepared by the board and published by
					 OptumInsight, which is herein incorporated by reference.
(b) The Official New York Workers'
					 Compensation Medical Fee Schedule incorporated by reference herein may be
					 examined at the office of the Department of State, One Commerce Plaza, 99
					 Washington Avenue, Albany, NY 12231, the Legislative Library, the libraries of
					 the New York State Supreme Court, and the district offices of the board. Copies
					 may be purchased from OptumInsight, by writing to Official New York Workers'
					 Compensation Fee Schedule, PO Box 88050, Chicago, IL 60680-9920; by telephone
					 at 1-800-464-3649, option 1; or online at
www.optum360coding.com
keyword New York or
https://www.optum360coding.com/Product/40508/
(c) Authorized providers who
					 utilize the Official New York State Workers' Compensation Fee Schedule shall
					 use the following Common Procedural Technology (CPT) codes when telemedicine is
					 used in accordance with section
					 325-1.8  of
					 this Title. Use of these codes are limited to one unit per patient per day. Use
					 of these codes are not eligible for the enhanced reimbursement set forth in
					 Modifiers in 1B or 1D of Ground Rule 9.
(1)
					 99441 (telephone evaluation and management services provided to an established
					 patient; 5-10 minutes of medical discussion);
(2) 99442 (telephone evaluation and
					 management services provided to an established patient; 11-20 minutes of
					 medical discussion); and
(3) 99443
					 (telephone evaluation and management services provided to an established
					 patient; 21-30 minutes of medical discussion).