New York State workers’ comp has specific billing and reporting requirements — but every rule has its exceptions.
As explained in a previous article, the Workers’ Compensation Board (WCB) requires providers to include a narrative report with each bill substantiating the charges. Previously, the WCB stressed the importance of three critical elements of the narrative report, failure to include which may result in non-payment:
However, the WCB recently announced that the provider’s failure to include one or more of the above should not be the sole basis for denying payment. According to the WCB, under certain circumstances, one or more of the three required elements may not be necessary or applicable.
The WCB announced that it may resolve payment disputes in the provider’s favor, when the claims administrator’s only objection to payment is that the narrative report is missing the temporary impairment, work status, or causal relationship.
Read on for details, including exception examples provided by the WCB.
Along with the bill, providers must send a report in the form of a medical narrative attachment. The WCB offers an optional template for the report, which includes the three elements providers must have “at the top of, or prominently displayed on” the report: information regarding temporary impairment, work status, and the causal relationship.
But, a November WCB bulletin explains that “There are several instances…in which this information is not as critical to the payer, or the Board, and it is not needed to properly adjudicate the medical bill.” For example:
Consequently, the WCB wants payers (and presumably providers) to know:
Bottom line: while New York providers should always include the three elements discussed here where applicable in the narrative medical report, failure to do so is not by itself a valid reason for denial of payment.
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