Last month, New York’s Workers’ Compensation Board (WCB) hosted one of its regular webinars updating providers on significant changes to the system, both active and pending.

From a push to increase provider reimbursements to significantly streamlined administrative processes, the state has made a concerted, years-long drive to improve access to care for injured workers and encourage provider participation.

The WCB’s webinars are valuable checkpoints for providers navigating the various reforms reshaping the comp landscape for practices. Below, we share 5 key takeaways from the most recent online event.

1. Higher E/M Rates Are in the Works

The WCB has been pushing for higher reimbursement rates for providers, with a specific focus on reimbursements for Evaluation and Management (E/M) services.

At the webinar, WCB Medical Director Dr. James Tacci highlighted a proposed 50%-75% increase in reimbursement rates for commonly-used E/M codes, with the increase varying by geographic area.

As Dr. Tacci explained, the overarching mission is to make comp reimbursements competitive with reimbursements under private group insurance (emphasis ours):

“The motto or the mantra that we very often follow is that if someone falls and sprains their back on their steps at home versus falling and spraining their back on the steps at work, the doctor treating them should not get paid more under private health insurance than they do necessarily under the workers' comp system.”

2. Higher Deposition Fees Proposed

Along with higher E/M reimbursements, the WCB is pushing for a modest increase to provider fees for depositions. A June 2026 proposal would modify New York Codes, Rules, and Regulations to raise physicians' deposition fees to $500, up from $450.

Moreover, providers would no longer have to bill for deposition fees; the payment will be deemed ordered by the judge, making the carrier automatically responsible for payment.

However, if the payer fails to pay a deposition fee, the provider may submit a Request for Decision on Unpaid Medical Bill(s) (Form HP-1.0), as with a typical unpaid bill. There would also be significant penalties for late payment.

3. MTG Updates on the Way

With the most recent update having taken effect in 2022, the WCB will reconvene the Medical Advisory Committee (MAC) to update the state Medical Treatment Guidelines (MTGs) and the state’s drug formulary.

The WCB will tackle the project by first prioritizing MTGs based on several factors, including:

• The age of the MTG
• The frequency of the conditions the MTG addresses
• Medical and clinical developments and advances
• Opinions of MAC members

The MAC comprises a mix of physicians selected by labor and business representatives and the WCB, with subject-matter experts overseeing proposed changes in their respective specialties. Proposed new MTGs will be subject to public comment.

4. Speeding Up Billing Disputes

According to WCB Deputy Director Audrey Maiello Cunningham, the WCB has made major strides in speeding up the billing dispute resolution process, including:

• Tackling a massive backlog of disputes
• Updating the OnBoard system to flag duplicate disputes
• Adding an attestation requirement to the HP 1.0 Form

The result: the WCB estimates turnaround times for billing disputes are between two and three months, down from roughly two years previously.

Cunningham also reminded attendees that providers can now submit HP-1.0 forms to dispute payers’ failure to reimburse for CPT code 99080, which providers use to bill payers for the cost of complying with mandatory electronic billing.

Additionally, Cunningham encourages providers to consult the WCB’s updated Medical Billing Disputes web page for specific instructions for various dispute scenarios.

5. Tips for Better PARs

The WCB celebrated successfully moving all Prior Authorization Requests (PARs) online, touting the millions of PARs that have passed through the system with minimal friction. The WCB offered several tips for providers to “expedite” their PARs going forward:

1. Submit the correct type of PAR, e.g., MTG Variance, MTG special services, Durable Medical Equipment, etc.
2. Submit supporting documentation with each PAR, e.g., diagnostic imaging and test results.
3. Use the MTG lookup tool in the medical portal to quickly research which treatments align with the MTG for various conditions.
4. Check frequently for insurer responses to your PARs and supply additional information when necessary.
5. Include a clear clinical rationale for every PAR in the medical narrative section.
6. When escalating a PAR to the Medical Director’s office, include a rebuttal that specifically addresses the payer’s denial rationale in the “Escalation Reason” field.
7. Use the correct MTG reference codes with every PAR.
8. Use the recently added dropdown options to indicate the frequency and duration of requested treatment.
9. Keep your provider information (e.g., address changes) up to date, especially if information changes while you have a PAR pending.

With measures like mandatory electronic billing already in place, universal provider authorization taking effect in 2028, and other reforms on the horizon, New York and the WCB are on a tear. In all likelihood, these efforts to create a provider-friendly comp environment will ultimately improve injured workers’ care and outcomes.

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