Millie Suk, JD, MPP, AANEM Health Policy Director, recently reached out to AANEM members in the state of New York to inform them about an AANEM letter to be sent to the New York Worker’s Compensation Board very soon. This letter is in response to the NY Worker’s Compensation Board’s proposed changes
to the Medical Fee Schedule.
“The new fee schedule would result in some substantial cuts in reimbursement for EDX testing,” stated Ms. Suk. “I encourage all AANEM members in New York to reach out to the New York Worker’s Compensation Board to oppose these changes. It is important that we all do our part to take action on this matter to ensure EDX testing is properly reimbursed by worker’s compensation in New York State.”
Key Points in AANEM’s Letter
- In 2013, the Centers for Medicare & Medicaid Services (CMS) changed the CPT codes and significantly reduced the reimbursement for services provided by EDX physicians. The Relative Value Units (RVUs) that CMS established for needle electromyography (EMG) and the new nerve conduction codes in 2013 resulted in a 32% to 67% reduction in reimbursement for these procedures provided to Medicare patients.
- These cuts have had a devastating effect on EDX practitioners. In a survey of our members taken shortly after these cuts were announced, 63% of our EDX physicians indicated that they were very likely to limit the number of Medicare patients they saw. Over 30% stated that they were very likely to close their practices. Based on extensive communications with members, both of these predictions appear to have come true.
- If New York changes the CPT codes to the new ones established by CMS, it will result in a cut of reimbursement of up to 63% for some codes. The impact of this will likely be that an even greater number of EDX practitioners will have to reduce their EDX practices, limit the number of worker’s compensation patients they see, or even close their doors.
- AANEM members in New York have reported that the professional and administrative time required to provide care to a worker’s compensation patient is double or triple that required to treat a patient insured through No Fault, Medicare, or a private payer due to requirements of sending the bill to three different entities (the Board, the Carrier, and the Attorney/Claimant), requiring a paid partnership with a Board-approved XML partner to submit form EC4Narr, having to deal with IMEs and depositions and numerous other requirements.
- According to the published Proposal, the goal of the proposed changes are, “To increase provider participation in worker’s compensation system and improve injured workers’ access to timely, quality medical care, the Worker’s Compensation Board (Board) is proposing an increase to provider fees.” Unfortunately, if the Board adopts the new CPT codes, it will result in drastic cuts to reimbursement for EDX studies.
- If New York is looking to reduce costs and still maintain quality EDX care, we would encourage you to:
- Only pay for qualified providers to perform nerve conduction studies and needle EMG testing – neurologists and PMR physicians.
- Consider AANEM laboratory accreditation, ABEM certification, and other screening methods to identify trained providers and technicians.
- Require the physician supervising technicians be neurologists or PMR physicians instead of allowing a physician with no EDX training to be considered the “supervising physician.”
- Set policy to exclude payment for studies performed using nontraditional devices that are incapable of real-time waveform display and analysis and/or incapable of performing both nerve conduction and needle EMG testing.
- In conclusion, AANEM strongly encourages enacting reimbursement policies that mandate only trained neurologists or PMR physicians perform EDX evaluations, while also considering using certification or EDX laboratory accreditation programs and board certifications as a basis for worker’s compensation reimbursement. We believe these initiatives will ensure appropriate utilization while continuing to provide safe, cost-effective services that will ultimately improve the overall quality of healthcare.
How to Take Action
AANEM members in New York are encouraged to submit their input to the New York Worker’s Compensation Board to firstname.lastname@example.org
by August 6, 2018.
Questions on this topic can be sent to Ms. Suk via email