Workers' Compensation Board's Treatment Utilization Pilot Program

Circular Letter No. 35 (2000) December 11, 2000 TO: All Licensed Property/Casualty Insurers Authorized To Write Workers' Compensation Insurance In New York State RE: Workers' Compensation Board's Treatment Utilization Pilot Program The New York State Workers' Compensation Board (WCB) is conducting a Treatment Utilization Pilot Program focused on Authorized Orthopedic Specialists in the Buffalo, New York area. The purpose of this program is to determine whether higher reimbursement rates have an effect on reducing utilization. The WCB will establish an evaluative methodology to review and evaluate the experience of the treating physicians during the pilot project. As part of the pilot program, the WCB is authorizing, for accidents occurring on or after December 1, 2000, that participating providers be reimbursed in accordance with the Region 4 (New York City area) rates. These reimbursement rates will be in effect for a period of three years, or as long as the participants continue to participate in this pilot program and meet the data reporting requirements as defined by the WCB. A list of participating providers and the fee schedule will be sent under separate cover by the WCB. Please note that the pilot program's fee schedule should not be used for reimbursement to participating providers under any other program, such as New York's No-Fault law. The WCB has also established a control group of 100 randomly selected orthopedic specialists in Region 2. Insurers will be required to submit an electronic data set for this control group to the WCB on a semi-annual basis. The WCB will notify you of the specific dates that these reports should be submitted. Providers making up that control group are listed in Attachment 1 of this letter. The format for the electronic reporting of this control group is described in Attachment 2. The receipt of this data by the WCB is essential and will form the comparative basis for the study. The (WCB) has established the data reporting requirements contained in Attachment 2. In addition to the instructions contained therein, please note the following: All data must be provided in an ASCII delimited (tab or comma) file. Large files should be compressed or zipped. All files must have the appropriate header columns to differentiate the data elements. Please complete the contact information form (Attachment 3 to this letter) and return the information, within 10 days of the receipt of this Circular Letter, to: New York State Workers' Compensation Board Bureau of Health Management - Att.: Lynne Cuva, Room 200-B 20 Park St. Albany, NY 12207 If you have any questions regarding the pilot program or the reporting requirements, please contact Lynne Cuva (518-486-3330) or Mark Arunasalam (518-402-6361) at the WCB. Very truly yours, Mark Presser Assistant Deputy Superintendent and Bureau Chief Property Bureau Attachment 1 Control Group Orthopedic Specialists Data to be submitted on a semi-annual basis WCB# Provider Name 100795-4 Al-Khalidi Farouq 070782-8 Altchek Martin 039206-8 Bastable Stephen 103551-8 Benton Louis J Jr 122662-0 Bernstein Michael L 199426-8 Bessette Gary Charles 153339-7 Bhanusali Govindlal K 107052-3 Buerkle August R Jr 090643-8 Burton Richard Irving 112578-0 Cady Robert Brown 143337-4 Cambareri John Joseph 194781-1 Cannizzaro John Patrick 187689-5 Capecci Robert 143645-0 Carl Allen Laurence 092763-2 Carpenter Charles Worden 187687-9 Carrier David Alan 089524-3 Carrier Robert Hodge 208747-6 Chambers Robert Edward 156784-1 Ciszewski William Andrew 087506-2 Cole Harry Maurice 164065-5 Connolly Patrick J Jr 187784-4 Daino Terrance Michael 196389-1 Damron Timothy Arthur 150394-5 Decamp Christopher D 122689-3 Dehaven Kenneth E 192639-3 Delsavio Gina Carmela 156054-9 Delsignore Jeanne Louise 076974-5 Dickerson Robert Cushman 188755-3 Federowicz Daniel Patrick 103596-3 Ferrando-Bort Isidro 122366-8 Fredrickson Bruce E 123838-5 Freedman Peter A 170254-7 Fuchs Marc David 099215-6 Godesky Mary T 187986-5 Goldstock Leonard Eric 071619-1 Gootnick Lester Theodore 170239-8 Greenky Brett Bryan 162177-0 Greenky Seth S 196161-4 Grimm David Charles 097375-0 Haake P William 202111-1 Hansraj Kenneth Karamchand 087518-7 Heineman Robert K Jr 210288-7 Hepner Roy A 072960-8 Holmblad James E 128072-6 Hootnick David Randall 182146-1 Israelski Ronald Henry 120941-0 Jacobs Richard L 187047-6 Katz Richard Lorne 120136-7 Kim Kenneth K 117583-5 Kim Myung Hyo 101393-7 Kunze Wilfried 213827-9 Kusior Lawrence Joseph 206267-7 Lauritzen Renee Smith 143383-8 Lee H Binn 076629-5 Lim George 080344-5 Mandel Joel E 168756-5 Maynard Michael Jude 134605-5 McClure Michael G 204524-3 Mears Dana Christopher 120402-3 Moskowitz Alan 188446-9 Murphy Daniel James Jr 169535-2 Newman P James 141333-5 Nunez Louis David 198104-2 Olcott Christopher William 163383-3 Ortega Kenneth David 083883-9 Pachmakova Weiss Ahinora 100628-7 Pearce David F 120956-8 Pearson Harold W 172267-7 Pedersen Arne K 133246-9 Pleger Philip G 078513-9 Quinn Brian O Malley 213245-4 Rauschenbach Kenneth K 126879-6 Reina Charles R 110026-2 Riegler Hubert F 112037-7 Rinehart Warren T 100368-0 Rosenberg Irwin Joseph 197106-8 Scerpella Patrick Richard 137945-2 Scheinzeit Ronald Steven 110636-8 Schrock Robert D Jr 087062-6 Sears Kendrick Alan 103116-0 Sequeira Denzil A L 134913-3 Shankman Gregory Bernard 199450-8 Siegrist Stephanie E 136743-2 Slavin James A 167883-8 Smith William James 205109-2 Soyer Adam David 075450-7 States David Johnson 099107-5 Stetson John Waller 138770-3 Stram Richard A 120449-4 Striker James E 047395-9 Strobino Louis J 131222-2 Tebor Gary B 188429-5 Thomas James Anthony Jr 206940-9 Tigges Russell Gerard 106756-0 Toussaint Jon T 162670-4 Uhl Richard L 147849-4 Vella Ignatius Michael 127451-3 Wasyliw Orest M 137360-4 Webster Dwight Albert Jr 190181-8 Whalen John Thomas IV Attachment 2 Data to be submitted semi-annually Submit information at the individual medical treatment level of detail (i.e. line level, NOT bill level). Data should be submitted based on the dates of transaction for the reporting period. The required elements are listed in the following table: Data Elements Sample Record 1. Claimant Identification # (internal) 42674911 2. Claimant SSN# 09641713 3. Claimant Age or DOB (mm/dd/yy) 58 4. Claimant Gender Male 5. Date of Accident 08/17/00 6. Part of body injured (code) * 42 - Lower Back Area 7. Nature of injury (code) * 49 - Sprain 8. Diagnosis Code (ICD-9) 846 [line level] 9. Medical Treatment Code (CPT or others) 99214 [line level] 10. Medical Treatment Description (non-CPT codes only) [line level] 11. Medical type ME - Office Visit [line level] 12. Begin Date of treatment 08/23/00 [line or bill level] 13. End Date of treatment 08/23/00 [line or bill level] 14. Amount of medical treatment billed 45.78 [line level] 15. Service provider Tax ID# 012-34-5678 16. Service provider WCB# (if applicable) 123456-8 * Use New York Workers' Compensation Insurance Rating Board Statistical Plan - Part VIII-Statistical Codes 1. Data submission To facilitate data management, the data elements can be incorporated into three(3) basic tables in order to avoid data redundancy and enable data normalization. These tables should encompass: Medical transactions - data elements 1, 8, 9, 10, 11, 12, 13, 14, 15, Claimant Information - 1, 2, 3, 4, 5, 6, 7 Provider Information - 15 and 16 Please provide data files in ASCII-text (delimited) format. 2. Additional information on data elements: Item#11.   Medical type - kindly categorize all medical treatments, into the following, OR use equivalent. HP - Health provider charge OH - Hospital Outpatient IH - Hospital Inpatient ER - Emergency Room Etc. Attachment 3 Contact Information Carrier Name _________________________________ Address _________________________________ _________________________________ _________________________________ Contact Person _________________________________ Telephone number _________________________________