The "8-Unit Rule"

Posted By Erin S. Stamper || 6-Mar-2018

While the 8.0 Relative Value Units (“RVU”) limit set forth in in Ground Rule 11 of the Physical Medicine Section of the Workers Compensation Board (“WCB”) Fee Schedule appears to allow multiple providers, with disparate skill sets, who are treating different conditions on the same date, to obtain reimbursement for the No-Fault benefits provided, the Firm anticipates that no-fault arbitrators, without more formal guidance regarding WCB’s intent, will continue to issue disparate decisions regarding the 8-Unit Rule.

The Firm’s opinion in this matter is based on a communication recently received from a Vice President of the American Arbitration Association (“AAA”), the not-for-profit organization which administers the arbitration of disputed No-Fault claims on behalf of the New York State Department of Financial Services. On April 23, 2018, the Firm received the following e-mail from Vice President James Skelton:

From: James Skelton <SkeltonJ@adr.org>
Sent: Monday, April 23, 2018 11:00 AM
To: Bruce Klein <bklein@rfriedmanlaw.com>; Erin Stamper <estamper@rfriedmanlaw.com>
Cc: Chris.Maloney@dfs.ny.gov
Subject: Fee Schedule - PT Rules

Dear Bruce and Erin - The Workers’ Compensation Board has recently advised the Department that the following email regarding PT rules is not the Board’s official position. If you have any questions, please contact Chris Maloney at chris.maloney@dfs.ny.gov or (212) 480-5586.

Christopher Maloney

Supervising Insurance Examiner

Property Bureau – Claims Administration Unit

New York State Department of Financial Services

One State Street Plaza, 6th floor, New York, NY 10004+1511

Ph: (212) 480-5586 | Fax: (212) 709-1570 | chris.maloney@dfs.ny.gov

www.dfs.ny.gov

From: MacMaster, Heather (WCB)
Sent: Tuesday, January 30, 2018 3:59 PM
To: Maloney, Chris (DFS) <Chris.Maloney@dfs.ny.gov>
Cc: Woods, MaryBeth (WCB) <MaryBeth.Woods@wcb.ny.gov>; Smith, Steven (WCB) <Steven.Smith@wcb.ny.gov>
Subject: Fee Schedule: PT rules

Chris:

Here is the PT information from our MDO.

The 8 RVU limitation is per patient per day regardless of how many body parts are treated or how many practitioners treat. The only exception is with chiro and PT. If a chiro renders manipulation only (98940-98943) and does not bill any of the other physical medicine codes, the injured worker could receive chiro and PT on the same day. This scenario is usually performed by a chiro who is affiliated with the Chiropractic Council. They only perform manipulation.

The physical medicine codes that are impacted by the 8 RVU limitation are in the chiro physical medicine fee schedule but the codes for spinal manipulation are not in the general physical medicine fee schedule.

Thanks,

Heather

Heather MacMaster

Deputy General Counsel

NYS Workers’ Compensation Board

328 State Street, Schenectady, NY 12305

(518) 486-9564 | heather.macmaster@wcb.ny.gov

http://www.WCB.NY.Gov

Confidentiality Notice: All contents of this message, including any attachments, may be confidential and/or legally privileged. Contents are intended for the recipient only. Any other use, dissemination or disclosure is unauthorized. If you are not the intended recipient, please notify the sender and delete the message and any attachments immediately.

James Skelton
Vice President

American Arbitration Association
32 Old Slip, 33rd Floor, New York, NY 10005
www.adr.org
T: 917 438 1562

Our office has moved. The new address is 32 Old Slip, 33rd fl, New York, NY 10005

The information in this transmittal (including attachments, if any) is privileged and/or confidential and is intended only for the recipient(s) listed above. Any review, use, disclosure, distribution or copying of this transmittal is prohibited except by or on behalf of the intended recipient. If you have received this transmittal in error, please notify me immediately by reply email and destroy all copies of the transmittal. Thank you.

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