Fall BPR Project Director Update!

Fall 2015 BPR Update

For those of you who do not know me, I would like to take this opportunity to introduce myself. My name is Deena Jones, and I have been the Program Sponsor of the BPR program for the last several months. I have worked on the BPR project since its inception in my previous role as Project Coordinator and worked very closely with my predecessor, Brian Collins.

Brian retired from the Board earlier this summer, and I want to wish him the best in his future pursuits. He filled the role of Project Director admirably, bringing his persistence to every challenge we encountered. Although I will miss his generosity and good cheer, I am excited at the prospect of upholding the high standards he set for the BPR and ensuring that the project is a success.

Many of the BPR initiatives have gained traction since Brian's last update, which is great news! I have a lot to share about the progress—here are the latest developments.

Under the Quality Medical Care initiative, the Board has completed its transition to the Enhanced Ambulatory Patient Groups (EAPG) based ambulatory fee schedule, which was effective October 1, 2015. This change in methodology will enable the Board to stay aligned with the NYS Department of Health (DOH), which has moved to EAPG for outpatient services. EAPG also supports ICD-10 codes, which is important to the Board's adoption of ICD-10, which was also effective on October 1, 2015.

The Board's transition from ICD-9 to ICD-10 was timed to coincide with the Centers for Medicare and Medicaid Services (CMS) adoption of ICD-10. Administratively, this change enables the Board to be consistent with other major medical systems, ensuring that the Board stays up to date and reduces provider's and payer's burden of supporting multiple systems.

The Monitoring and Compliance unit has been pressing forward with its education and outreach on the performance program for payers. A webinar on timely reporting of notices of controversy was held in September. If you missed the live webinar, a pdf of the PowerPoint presentation is available on the Monitoring and Compliance page of the Board's website. If you have any questions at all about the performance program or specific questions about submitting reports, please email the Monitoring and Compliance unit at monitoring@wcb.ny.gov

Monitoring and Compliance has also reached an important milestone. On September 30, 2015, the trial period for timely submission of first reports of injury (FROI) ended, and official tracking began on October 1, 2015—marking the live implementation of the first phase of the performance program! This successful milestone ushers in much-needed oversight and will ensure that the system runs properly well into the future.

On the Medical Portal project front, the working team is currently in the development and design phase of the portal. A phased implementation is being planned for health care providers, payers, attorneys, and injured workers. Be on the lookout for communications regarding webinars and the portal registration process. I look forward to sharing future developments with you.

The implementation of Voluntary Binding Review (VBR) has also been moving forward. To refresh everyone's memories, VBR is an alternative appeal resolution process that will enable the parties involved to enter into a binding review of the issue on a voluntary basis instead of going through the conventional appeals process. Parties that enter into VBR agree that once the determination is made, it is final and binding. The resolution only affects the specific issue on appeal as agreed upon by the parties, and does not constitute a final disposition of the entire claim. The benefit of VBR is that claims are resolved faster, which benefits injured workers as well as the other parties in the claim. The Board's Administrative Review Division will also be able to reduce its backlog of cases significantly. We anticipate an official release of VBR sometime in early 2016.

The Board is beginning a BPR initiative to implement virtual hearings. Virtual hearings are video-based hearings that use state-of-the-art video conferencing equipment. Virtual hearings will enable the parties to meet without having to be physically present at a hearing site. Injured workers may choose to go to their attorney’s office to participate in their hearing, or they may participate from home. Parties of interest wishing to participate in a virtual hearing will need to utilize specified hardware and have access to reliable high-speed Internet service. When more of the technology details are worked out, I will be able to share the specific requirements and a date for the pilot phase of the project. Subsequent phases of this initiative will include modernization of the calendaring process, which will expedite hearings.

The last BPR initiative I want to tell you about is the Call Center Upgrade project, which has been steadily transferring Level 1 calls to the Human Services Call Center (HSCC). To date, nearly all Level 1 calls are now being handled by HSCC. This means that Board customer service representatives have more time to devote to Level 2 calls that require workers' compensation expertise, enabling them to improve service to injured workers and other stakeholder groups.

Finally, some housekeeping items—the discussion document from the June/July roadshows is now available on the District Dialogues page of the Board’s website at 2015 BPR Roadshow Discussion Document. This document is a synthesis of all the questions and discussions that came up during the summer roadshows. Feedback from the September/October District Dialogue meetings will be published very shortly. Please monitor the BPR section of the Board's website for the latest information. As always, if you have any questions, concerns, or ideas to share, please send an email to the BPR mailbox at BPR@wcb.ny.gov