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Resident and fellow physicians

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Overview

Physicians who are training in residency and fellowship programs can play an important role in helping New Yorkers recover from work-related injuries and illnesses.

Board authorization

Resident and fellow physicians credited by the Accreditation Council on Graduate Medical Education (ACGME) are not required to apply for authorization and may treat injured/ill workers within the NYS workers' compensation system under the appropriate supervision of faculty physicians. See the Welcome Residents and Fellows Physicians page for more information.

Treatment

Treatment of workers' compensation patients follows standards of care set forth in the New York Medical Treatment Guidelines (MTGs). There are currently 16 MTGs that address the most common injuries and illnesses within the workers' compensation system. Providers have access to an easy-to-use online MTG Lookup tool to check treatment protocols.

The New York Workers' Compensation Drug Formulary (Drug Formulary) lists the medications that can be prescribed to treat injured workers, consistent with the MTGs.

Health care providers who wish to provide treatment and medication that fall outside of the MTGs and Drug Formulary must obtain prior authorization. Health care providers can submit (and check the status of) prior authorization requests (PARs) using the Board's online system, OnBoard. Thus, if fellows wish to provide care that falls outside of the MTGs or Drug Formulary, they should consult with their supervising physician about the PAR submission process.

See: Medical Treatment Guidelines; New York Workers' Compensation Drug Formulary; OnBoard

Clinical notes: Required elements

Fellow clinical notes should clearly identify the fellow providing the care, as well as the name of the supervising physician (as is required for other insurance programs).

Just like all physician notes in the workers' compensation system, fellow clinical notes are required to clearly state:

  1. whether the condition was caused by work;
  2. whether the patient is working; and
  3. the patient's percentage of temporary disability.

PARs through OnBoard

NOTE: Resident and fellow physicians who wish to provide treatment or medication that falls outside of the Medical Treatment Guidelines and Drug Formulary, should consult with their supervising provider about the PAR submission process - all PARs must be submitted by the supervising provider/physician.

Billing

Non-surgical services provided by residents and fellows are billed by the supervising physician at the regular Official New York Workers' Compensation Medical Fee Schedule, using the modifier 1R. This modifier does not reduce the amount of the fee billed; it identifies that the services were provided by a resident or fellow physician, under the supervision of the authorized billing physician. In instances where the resident or fellow physician assists during surgery, the fee is billed by the surgeon using modifier 84 and paid at 16% of the applicable physician code fee.

Resources

Here are some helpful resources for health care providers in the NYS workers' compensation system.

  • Health care provider webpage: a section of the Board's website specifically for health care providers.
  • Provider Toolkit: important resources, requirements, and updates for treating health care providers to be aware of regarding the workers' compensation system.
  • Training: courses, by topic, including the New York Medical Treatment Guidelines, New York's mandatory standard of care for treatment in the workers' compensation system.
  • OnBoard overview: an introduction to the Board's online system that health care providers use to submit and check the status of prior authorization requests (PARs) for medical treatment and submit requests for review of medical billing disputes.
  • Webinars: the Board regularly hosts webinars for health care providers and other stakeholders, and recordings are posted online. See the Recorded Webinars page to view past webinars or the Upcoming Webinars page to register for a future event.

To get a basic understanding of workers' compensation, it's recommended to view or attend a Workers' Compensation 101 webinar, hosted by the Board's Advocate for Injured Workers.

Contact the MDO

The Board has a Medical Director's Office, who has staff available to answer your questions about treating in the New York State workers' compensation system. You can contact the Medical Director's Office at MDO@wcb.ny.gov or by calling (800) 781-2362.

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