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Workers' Compensation Committee Update

Staff Contact: Lev Ginsburg

February 20, 2018

Workers' Compensation Committee Call

Thursday, March 15 at 1:00 PM
Call-in: 844-633-8697
Access Code: 952-95-336#

The 2017 reforms require the Workers’ Compensation Board to conduct a study of the utilization of IMEs. As part of the study, they are gathering utilization data by case characteristics, such as location, body part injured, carrier, IME entity, and ANCR, appeal and controversy indicators. They are also comparing NYS’ IME model to those of other states. In early 2019, the WCB report will be presented to the advisory committee whose task is to develop detailed recommendations to the Governor and Legislative leaders regarding administrative improvements and regulatory and statutory proposals that will ensure fairness and highest medical quality while improving methods of combating fraud. According to WCL 137(12), the report shall consider the feasibility of new methods of assigning IMEs such as through rotating providers or panels, statewide networks or other arrangements.

The Board will be holding a conference call for Business Council members to discuss the initiative, take questions and take responses to the questions listed below.

Please respond to Lev Ginsburg if you intend to join us in the discussion

The Board will present the following questions:

  1. What are your primary concerns with the use of IMEs, specifically related to:
    1. Quality/Thoroughness of exams
    2. Completeness of reports
    3. Usefulness of reports
    4. Scheduling/Cancellations
    5. Independence/Quality of IME providers
    6. Cost of IMEs
    7. Access to IME providers/reasonable accommodations
    8. Other
  2. What aspects of the IME process are subject to fraud/abuse and how could these gaps be closed?

  3. What is your experience and opinion on the advantages/disadvantages of using one of the following models for IMEs:
    1. Rotating providers or panels
    2. Statewide networks
    3. In-house providers (State Doctors)
    4. External vendor
    5. Other?
  4. What studies in addition to the statewide 2015 IAIABC IME study are you aware of that should be reviewed and analyzed for this report?

  5. Does your organization have any IME data or reports that you can share for this study?

  6. What do you consider to be industry best practices regarding use of IMEs?

  7. In which of the following areas do you think WCB should provide regulatory oversight:
    1. Contractural IME fee schedules between carriers and IME entities
    2. No show fees
    3. Billing codes used for IME services
    4. Registration of IME providers/entities
    5. Other
  8. Other comments/issues?

Lev Ginsburg, Esq. | Director of Government Affairs
The Business Council of New York State, Inc.
111 Washington Avenue, Ste 400 | Albany, NY 12210
Tel. 518.465.7511 ext. 207 | Fax 518.465.4389
lev.ginsburg@bcnys.org | www.bcnys.org