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Revised Health Care Provider Bill Arbitration Procedure


Chapter 639 of the Laws of 1996 ("Health Care Reform Act") amended Sections 13-g, 13-k, 13-l and 13-m of the Workers' Compensation Law, effective January 1, 1997, as they relate to the arbitration of disputed health care provider bills.

This chapter requires the Chairman to determine by regulations the fee to be paid by providers initiating requests to arbitrate disputed bills. The chapter also requires that fees collected for this purpose be used to cover the conduct of such arbitrations.

Under the provisions of this chapter, the amount due the provider, if the disputed bill is resolved in his or her favor, shall be increased by the amount of the fee paid to initiate the arbitration request. Where a partial award is made, the amount due, based upon the bill(s) in dispute, shall be increased by a part of such fee.

In order to comply with the statutory requirement that arbitration costs be supported by the fees collected, the following fee structure for initiating arbitration requests will be promulgated by the Chairman, effective January 1, 1997:

Amount of Dispute/Fee

The rules to be promulgated by the Chair affect requests for arbitration relating to health care provider services rendered on or after January 1, 1997.

Requests for arbitration relating to services rendered on or after January 1, 1997, should be submitted on revised Form HP-1 (12-96).

To help reduce confusion over arbitration fees, separate HP-l forms should be used to request arbitration of health care provider services rendered prior to that date.

No arbitration fee shall be refunded, unless Form HP-4, Withdrawal of Request for Arbitration, executed by both the carrier and the health care provider, or initiated by the health care provider alone, has been filed with the Board a minimum of 30 days prior to the initial scheduled date of arbitration.

Chapter 639 also provides that arbitration regarding payments for inpatient hospital services for any patient discharged on or after December 31, 1996 shall, once again, be resolved in accordance with Section 13-g of the Workers' Compensation Law.

The process of filing requests for arbitration of disputed inpatient hospital bills, therefore, will be identical to the procedures governing the arbitration of all other hospital services, subject, of course, to the revisions described elsewhere in this notice.

Copies of revised Forms HP-1 and HP-4 are attached. Additional supplies of these forms may be obtained from County Medical Societies or your professional organization. In the alternative, you may request copies from the Workers' Compensation Board, 100 Broadway-Menands, Albany, New York, 12241, Attention: Reproduction Unit.

If you have any questions pertaining to the amended process and/or your responsibilities under it, please contact the Disputed Bill Unit at 1-800-781-2362.

Thank you for your cooperation.

 

Robert R. Snashall
Chairman