IX. Worker's Compensation/No-Fault Payments


Question 1: Do HCRA surcharges apply to payments made pursuant to the NYS Workers´ Compensation Law, NYS Motor Vehicles Reparations Act, NYS Volunteer Ambulance Workers Benefit Law, and NYS Firefighters Benefit Law?

Question 2: Are the HCRA surcharges included in the outpatient fee schedule issued by the NYS Worker´s Compensation Board and NYS Department of Financial Services for auto no-fault?

Question 3: When employers choose to make payments to designated providers for services rendered to employees with minor work-related injuries, rather than submitting the claim to their workers' compensation carrier, what surcharge rate is applicable?

Question 4: For purposes of the HCRA surcharges, is a person´s status as a Medicare beneficiary taken into account when workers' compensation payors are making payments to HCRA designated providers?



Question 1: Do HCRA surcharges apply to payments made pursuant to the NYS Workers´ Compensation Law, NYS Motor Vehicles Reparations Act, NYS Volunteer Ambulance Workers Benefit Law, and NYS Firefighters Benefit Law?

Answer 1: Payments made by payors to designated providers pursuant to the NYS Workers Compensation Law, the NYS Motor Vehicle Reparations Act, the NYS Volunteer Ambulance Workers Benefit Law, or the NYS Firefighters Benefit Law are subject to the HCRA surcharge, at rates based upon the payor´s election decision with the Public Goods Pool but no covered lives obligation or regional GME percentage surcharge.

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Question 2: Are the HCRA surcharges included in the outpatient fee schedule issued by the NYS Worker´s Compensation Board and NYS Department of Financial Services for auto no-fault?

Answer 2: The Worker´s Compensation Board and the NYS Department of Financial Services (formerly the NYS Insurance Department) did not amend their Worker´s Compensation or Motor Vehicles Reparations Act outpatient fee schedules to include the HCRA surcharge obligations. The surcharge is applicable when the service is provided by a designated HCRA provider, at a rate based upon the election decision of the payor (but no covered lives assessment or regional GME percentage surcharge).

Electing payors are obligated to report and pay the surcharges on their Public Goods Pool payor reports. When providers receive such revenue from non-electing payors, they are obligated to pay the higher non-electing surcharge rate to the Public Goods Pool and should assess this surcharge on their bills to the non-electing payor.

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Question 3: When employers choose to make payments to designated providers for services rendered to employees with minor work-related injuries, rather than submitting the claim to their workers´ compensation carrier, what surcharge rate is applicable?

Answer 3: Within the limited circumstances provided under Section 110 of the NYS Workers´ Compensation Law, employers making payments in these instances are considered "unspecified" payors whose HCRA liability is limited to the Self-Pay Uninsured/Unspecified rate when billed by HCRA designated providers. There is no obligation in these instances to the regional GME percentage surcharge.

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Question 4: For purposes of the HCRA surcharges, is a person´s status as a Medicare beneficiary taken into account when workers´ compensation payors are making payments to HCRA designated providers?

Answer 4: Yes. For Medicare covered services, payments to HCRA providers by workers compensation payors are exempt from HCRA surcharges for services Medicare would cover. For services that are not eligible for coverage by Medicare, the workers compensation payor would owe a HCRA surcharge, at rates based on the election status of the workers compensation payor, but no covered lives assessment or regional GME percentage surcharge.

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