The new Medical Fee Schedule (Pathology and Laboratory section, Ground Rule 12), updating the reimbursement for services to injured workers, takes effect April 1, 2019. The NYS Workers Compensation recently issued guidance on clarifying that the Non-Acute Pain Medical Treatment Guidelines recommendations govern urine drug testing.
An excerpt of the Non-Acute Pain Medical Treatment Guideline criteria is provided as a reference.
The new Medical Fee Schedule incorporates standards from the Board’s 2014 Non-Acute Pain Medical Treatment Guidelines and offers guidance as to the frequency of urine drug testing based on the level of risk for each patient. The updated rules do not contain the same level of detail, medical analysis and instructions as are contained in the Board’s Non-Acute Pain Medical Treatment Guidelines. Every medical provider should always use any applicable Medical Treatment Guideline when providing treatment and care to a workers’ compensation patient.
The Medical Fee Schedule states in every section that the Medical Treatment Guidelines set forth the standard of care and will prevail when there is a conflict between the two documents.
In Ground Rule 12, the Medical Fee Schedule identifies low/moderate/high risk test results and behavior and provides guidance as to how frequently urine drug testing may be performed in a medical provider’s office. The chart in the Ground Rule indicates that testing should be performed at different frequencies depending on a patient’s level of risk. The NAP-MTG on page 54 includes a similar chart. The chart in the NAP MTG sets forth that urine drug testing should be performed at least the annual allowable indicated for the applicable level of risk. The NAP MTG provide more detail and set forth the medical standards required for managing patients being treated for non-acute pain management.
As set forth on page 54 of the Non-Acute Pain Medical Treatment Guidelines, Risk Category (Score) and Random UDT Frequency:
• Low Risk patients should be tested at least once per year • Moderate Risk patients should be tested at least twice per year • High Risk patients should be tested at least 3-4 times per year • Any patient demonstrating aberrant behavior should be tested at the time of visit For more information, please review the Non-Acute Pain Medical Treatment Guidelines, First Edition, September 15, 2014.
On February 13, 2019, the New York State Department of Health provided the following advisory to physicians:
Effective April 1, 2018, a written treatment plan in the patient’s medical record is required if a practitioner prescribes opioids for pain that has lasted for more than three months or past the time of normal tissue healing.
There are exceptions for patients being treated for:
The treatment plan must follow generally accepted national professional or governmental guidelines, and shall include (but is not limited to) the documentation and discussion of the following clinical criteria within the medical record:
Such documentation and discussion of the above clinical criteria shall be done, at a minimum, on an annual basis.
For an example of a generally accepted national governmental guideline for prescribing opioids for chronic pain from the Centers for Disease Control and Prevention (CDC), visit https://www.cdc.gov/media/modules/dpk/2016/dpk-pod/rr6501e1er-ebook.pdf.
Additionally, AAOS has developed a Pain Relief Toolkit that can be accessed online: https://aaos.org/Quality/PainReliefToolkit/?ssopc=1
Check the Quality Payment Program Participation Status Tool to view your eligibility status for the 2019 performance period under the Merit-based Incentive Payment System (MIPS).
Enter your National Provider Identifier to find out if you need to participate in MIPS during the 2019 performance year.
For More Information:
Let the House of Medicine hear your voice! Every member of the New York State Society of Orthopaedic Surgeons has the opportunity to provide input regarding the development of policies and positions impacting orthopaedic surgeons and we encourage you to get involved!
Working with NYSSOS Board of Directors, NYSSOS members have advocated for Resolutions that have covered a variety of issues including:
Resolutions set forth background information and propose a course of action to change policy, laws and regulations at the state and federal levels. Resolutions are constructed with background information ("Whereas" clause/s) and conclude with a specific proposal oh how to change the issue at hand ("Resolved" clause/s).
When Crafting a Resolution Keep in Mind the Following:
OrthoInfo, the AAOS patient education website, is a free member resource that provides orthopaedic surgeons and patients with authoritative, in-depth information about musculoskeletal health.
The website features more than 400 articles, videos, and animations on common orthopaedic problems, surgical procedures, nonsurgical treatments, injury prevention, and healthy living.
All content is developed and peer reviewed by AAOS members.
OrthoInfo articles can help patients be better informed and participate more fully in their care and recovery.
Visit the site today
The AAOS Office of Government Relations, along with 15 other medical specialties, has given its support to legislation that would help relieve interns and residents of student loan debt. The bill (H.R. 5734), introduced by Rep. Brian Babin, DDS (R-Texas), would allow medical or dental interns or residents to defer their loans, interest-free. > Read More
In 2008, New York enacted an initiative called the Doctors Across New York Program to help train and place physicians in underserved communities in a variety of settings and specialties to care for New York´s diverse population. The program offers two tracks: the Doctors Across New York Physician Practice Support and Physician Loan Repayment programs. Due to statutory For a 3-year service obligation, there is a maximum amount of $120,000 provided for loan forgiveness. Learn more bout the program
The Centers for Medicare & Medicaid Services (CMS) launched a new online tool that allows patients to compare costs for certain procedures that are performed in hospital outpatient departments (HOPDs) and ambulatory surgery centers (ASCs).
The Procedure Price Lookup tool displays national averages for the amount Medicare pays and the national average copayment amount a beneficiary with no Medicare supplemental insurance would pay the provider.
For example, the average total cost of a total disk arthroplasty with diskectomy is $11,213 at an ASC versus $15,371 at a HOPD; the average total cost of an anterior cervical diskectomy is $7,337 at an ASC versus $10,123 at a HOPD.
The New York State Society of Orthopaedic Surgeons would like to recognize Paul Rubery, MD, Chairman for the Department of Orthopaedics at the University of Rochester Medical Center, and his commitment to supporting the Society's efforts. The department also supported each of its residents with membership to the Society!
The New York State Society of Orthopaedic Surgeons (NYSSOS) is the premier organization representing the orthopaedic community in New York in all practice settings. Your support will enable us to advance our mission and continue to grow!
Thank you!
The New York State Society of Orthopaedic Surgeons would like to recognize Leslie Bisson, MD, Chairman for the Department of Orthopaedics at the University of Buffalo, and his commitment to supporting the Society's efforts.
Thursday November 15, 2018 | 12:00 PM – 1:30 PM EDT
Register Here: https://engage.vevent.com/index.jsp?eid=3536&seid=1288
The Centers for Medicare & Medicaid Services (CMS) is hosting a webinar on Thursday, November 15, 2018 at 12:00 PM ET to provide information about the final rule for Year 3 (2019) of the Quality Payment Program.
During the webinar, CMS subject matter experts will:
The audio portion of this webinar will be broadcast through the web. You can listen to the presentation through your computer speakers.
CMS will open the phone line for the Q&A portion.
If you cannot hear audio through your computer speakers, please contact CMSQualityTeam@ketchum.com
Advocating for the orthopaedic surgeon, patients and musculoskeletal health in New York.
info@nyssos.org 1-518-439-0000 Address: PO Box 38004, Albany, NY 12203
