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With recent increases to medical fee schedules and adoption of the CMS-1500 universal medical billing form, treating patients in the NYS workers’ compensation system is now more in line with mainstream health care. However, there are some things that set treating workers’ compensation patients apart.
When treating a patient who was injured or made ill by their employment, there are three critical elements that providers must include in their medical reports. With these elements, lost wage benefits and medical payments can be timely made. These three musts are:
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Causality: Providers must state whether they believe the patient became injured or ill while in the scope of their employment or while performing duties related to their job, and what happened at work to make them injured or ill.
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Work Status: Providers must indicate whether the patient is currently working.
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Temporary Impairment: Providers must indicate the percentage (0-100%) of the patient’s temporary impairment due to the work-related injury or illness. This is also known as a degree of disability.
Template Available!
To help treating providers address these critical elements, the NYS Workers’ Compensation Board has an easy-to-use medical narrative template that includes prominent fields for each element. This template should accompany the CMS-1500 and treatment notes. We urge providers to adopt this brief, simple template and then add their treatment notes, as they otherwise may not have preset fields in their treatment notes to record these three elements. If providers prefer to use their own template or electronic medical record, please make sure to incorporate these three elements and label them at the top of your medical narrative.
Treatment notes alone, without these three elements prominently displayed, will not meet the threshold for lost wage benefits and may not yield provider payment for services.
Additional Information & Resources
For additional information and resources for providers, please visit the Provider page of the Board’s website at wcb.ny.gov/provider/. If you have questions, contact the Board’s Medical Director’s Office by email at WCBMedicalDirectorsOffice@wcb.ny.gov or by phone at 800-781-2362.
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