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At Russell Friedman & Associates our New York attorneys are dedicated to providing top-tier services to our clients every step of the way. For this reason, we believe it is important for clients and potential clients to have access to information regarding no fault and healthcare law. To assist individuals as best as possible, we have answered some frequently asked questions as well as providing information regarding recent case updates.
Today, the non-economic risks and responsibilities associated with proper billing of hospital claims are vast and onerous. In 2006, the federal government and, shortly thereafter, New York State, began enacting legislation severely restricting the ways in which hospitals may collect and retain their money.
Read MoreIn New York, it has long been established that hospitals have private rights of action to pursue liens on patients’ actions for personal injuries.
Read MoreFrom the onset, it must be stated that “medical transportation” is not defined in either Article 51 of the New York Insurance Law or Department Regulation 68 under N.Y.Comp. Codes R. & Regs. Tit. 11 § 65.
Read MoreThe thirty third amendment to regulation 83 and it's impact on the billing process of out-of-state medical providers.
Read MoreCommon billing issues exist across a broad-spectrum of the Firm’s hospital clients.
Read MoreNew Guidance from the Workers’ Compensation Board and the Impact on Multispecialty Group Practices.
Read MoreGenerally, all verification requests must be answered, either in whole or in part, within 120 days of the date of the initial request.
Read moreLearn more about Med Pay insurance and how it works in the state of New York.
Read MoreLearn more about the 3-year Statute of Limitations for Self-Insured Parties.
Read MoreOn June 6, 2018, a new medical fee schedule was proposed by the New York State Workers’ Compensation Board (WCB).
Read MoreNew York State Department of Financial Services (“DFS”) published the Proposed Ninth Amendment to Regulation 68 (“Proposed Amendment”).
Read MoreRussell Friedman & Associates submitted the following comments to the Proposed Ninth Amendment to Regulation 68.
Read MoreThe New York State Workers’ Compensation Board Increases Reimbursement Rates for Emergency Room Services for the First Time Since 1995.
Read moreOn July 3, 2019, the New York State Workers’ Compensation Board (WCB) proposed new fee schedule sections for Acupuncture, Physical, and Occupational Therapy.
Read MoreNew York filed a petition with the Nassau County Supreme Court for an order placing Maidstone Insurance Company (“Maidstone”) into liquidation on two grounds.
Read moreOn December 31, 2019, the New York State (NYS) Department of Financial Services (DFS) published in the State Register an emergency regulation (the 35th Amendment to Regulation 83), making clear that the new fee schedule sections for Acupuncture, Physical, and Occupational Therapy, and the amendment to the Chiropractic Fee Schedule that were adopted by the NYS Workers Compensation Board (WBC) will not apply to No-Fault (i.e. to treatment rendered to automobile accident victims) until October 1, 2020, and shall only apply to charges for health services performed on or after October 1, 2020.
Read moreThe Firm is prepared and continues to operate because the needs of its clients are of paramount importance.
Read moreOn March 16, 2020, the Workers’ Compensation Board (WCB) promulgated amendments to the Workers’ Compensation Fee Schedule, permitting doctors, acupuncturists, physical therapists, occupational therapists, chiropractors, psychologists, and licensed clinical social workers to engage in “telemedicine” during the COVID-19 crisis.
Read MoreOn August 11, 2020, a Liquidation Order was entered against both American Country Insurance Company (American Country) and American Service Insurance Company (American Service).
Read More
Use the following criteria when determining whether to refer an overdue or denied claim to the Firm to file in arbitration: 1. Bills that have been submitted to the insurer and to which no response has been received by the healthcare provider after 45 days from the date of submission 2. All claims for which an NF-10 Denial of Claim Form has been received by the healthcare provider, based on one of the following enumerated grounds: a. Fees Not in Accordance with Fee Schedule; b. Duplicate Procedures c. Lack of Medical Necessity (Peer Review or IME Cut-Off) d. Lack of Causation (Peer Review or IME Cut-Off) e. Treatment Not Related to the Use and Operation of a Motor Vehicle f. Treatment Not Related to Accident g. Result of an Investigation h. 45-day Rule (if healthcare provider has proof that it either timely mailed the bill or sent a reconsideration letter a.k.a. an appeal letter to the insurer) i. 30-day Rule j. IME No-Show k. EUO No-Show l. Benefits Exhausted/Exhausted Policy m. 120-day Rule (if healthcare provider has proof that it responded to the verification requests) n. No Coverage o. Fraud p. Fraud in Procurement q. Staged Accident r. Non-Cooperation s. Concurrent Care t. Excessive Care u. PPO v. Material Misrepresentation w. Driving While Intoxicated x. Application of Deductible y. One-Year Rule
If you are ever unsure about whether a claim should be referred to the Firm for arbitration, please contact either Bruce Klein, Partner, or Erin S. Stamper, the Supervising Associate of the No Fault & Health Care Law Department. Mr. Klein can be reached by email at bklein@rfriedmanlaw.com or telephone at (516) 355-9696. Ms. Stamper can be reached by email at estamper@rfriedmanlaw.com or by telephone at (516) 355-9684.
A 6-year statute of limitations applies to No-Fault insurance claims filed against private insurance companies (e.g. Geico, State Farm, Allstate, etc.), whereas No-Fault insurance claims against self-insured entities are subject to a 3-year statute of limitations. Self-insureds include municipalities, buses, trains, rental cars (where bills are sent to third party administrators), and MVAIC. The statute of limitations begins to run when the payment of the no-fault claim becomes “overdue”.
The documents needed to file in arbitration varies based on the type of healthcare provider that rendered the underlying services. Below are links to our filing Checklists.
1. Hospital No-Fault Filing Checklist
2. Hospital Physician Services No-Fault Filing Checklist
3. Ambulance No-Fault Filing Checklist
4. Non-Hospital No-Fault Filing Checklist
The Firm can accommodate your office’s preferred method for transferring collection files to RFA, including the following:
1. Citrix ShareFile (preferred)
2. USB Flash Drive
3. USPS Mail
4. Drop-Off
5. E-mail to newfiles@rfriedmanlaw.com
Be assured that all files delivered to RFA for collection, regardless of the transfer method, are entered into the Firm’s proprietary, HIPAA compliant system. Thereafter, the files are reviewed for both completeness and collectability. To the extent that additional information/documentation is required, you will be contacted by RFA. Any files that are deemed “non-collectable” shall be marked “Closed—Unopened/Returned to Client” in the Firm’s system. If you wish to utilize the Firm’s preferred file transfer method—Citrix ShareFile—we will provide Citrix ShareFile access to your chosen staff member(s).
The length of time that an arbitration can take varies greatly from case to case and is dictated largely by the American Arbitration Association’s (AAA) own calendar. Although developments during an arbitration proceeding can contribute to the speeding up or slowing down of a case, we make sure that all deadlines are met to ensure as speedy a process as possible. It currently takes the AAA upwards of 18 months to assign a first-time hearing date. During the period from filing to the hearing date, this office has had past success in conciliating and settling matters with advantageous terms. Such resolutions consider, not only the type of denial present, but the proofs provided by your office. Should we find pervasive practices influencing initial non-payment, we will share same in an effort to increase your practice’s voluntary recovery rate.
Through the Client Portal on the Firm’s website, you can discern the status of each case, from the Firm’s initial intake of documents to the case’s ultimate resolution. Copies of all past and future invoices, check images, arbitration awards, and other important information regarding your account are also available through the Client Portal.
Please contact our Intake Supervisor by email at newfiles@rfriedmanlaw.com
After settlement or an award, payment can generally be expected within 30-60 days. Under the Regulations, the No-Fault Insurer is given 30-days within which to pay a final settlement or Arbitration Award (with a few additional days for mailing). Once received, the check must get posted, scanned, deposited, and clear the Firm’s escrow account (if applicable). Provider accounts are reconciled and closed by the Firm on a monthly basis. If all the foregoing occurs prior to the completion of the monthly closeout, then the check will be remitted to the client with that month’s closeout report. If not, then the payment will be remitted to the client the following month. If, however, the No-Fault Insurer requests a master arbitration appeal, the timeframe for payment may increase to 121 to 180-days. If the No-Fault Insurer files either an Article 75 or a De Novo action after losing a master arbitration appeal, the timeframe for payment may increase to 365+ days.
Please contact Erin S. Stamper, the Supervising Associate of the No Fault & Health Care Law Department. She can be reached by email at estamper@rfriedmanlaw.com or by telephone at (516) 355-9684.
Please contact either Bruce Klein, Partner, or Erin S. Stamper, the Supervising Associate of the No Fault & Health Care Law Department. Mr. Klein can be reached by email at bklein@rfriedmanlaw.com or telephone at (516) 355-9696. Ms. Stamper can be reached by email at estamper@rfriedmanlaw.com or by telephone at (516) 355-9684.
We use negotiation, arbitration, or litigation to ensure medical providers are fairly compensated for their services.
We have a team of trusted and respected attorneys to ensure your case is matched with the best attorney possible.
We’re a client-centered, results-oriented firm. When you work with us, you can have confidence we’ll put your best interests at the forefront of your case – it’s that simple.
We fly throughout New England to meet with medical providers and hospitals to help them with collection, consulting and compliance.
No two cases are the same, and their solutions shouldn’t be either. Our attorneys provide creative points of view to yield exemplary results.
