A Brief History of Insurance Department Regulation 83
The No-Fault Fee Schedule Regulation
The Comprehensive Motor Vehicle Insurance Reparations Act, more commonly known as the New York No-Fault Law, became effective on February 1, 1974. The law was enacted to provide prompt payment of health related expenses and wage loss of those parties injured as a result of an auto accident.
There were a number of problems with the first No-Fault law, including abuses in health provider charges. As a result of such abuses, among the reforms to the No-Fault law that took effect December 1, 1977 was the implementation of fee schedules to control costs. These fee schedules govern virtually every health service expenditure payable by No-Fault.
Article 51 of the Insurance Law contains the provisions authorizing the establishment of a No-Fault reparations system for persons injured in motor vehicle accidents and Section 5108 specifically authorizes the Superintendent to adopt or promulgate fee schedules for health care benefits payable under the no-fault system.
In order to implement Section 5108, the Superintendent has promulgated Insurance Department Regulation 83. The Superintendent, in Regulation 83, adopted those fee schedules that are promulgated by the Chair of the Workers Compensation Board and has also established certain other fee schedules for professional health services for which schedules have not been established by the Chairman of the Workers Compensation Board. The fee schedules established by the Superintendent are contained in Appendix 17-C of Regulation 83.
The Workers Compensation Board fee schedules were initially adopted in 1977 and have been revised regularly since that time in order to reflect inflationary increases and to incorporate new procedure codes as well as other necessary enhancements. Periodic revision to these fee schedules is a part of the ongoing process of keeping the fee schedules current and reflective of changes in the health care industry, thereby facilitating access to health care for motor vehicle accident victims while controlling costs. Similar modifications and improvements have also been applied to those fee schedules established by the Insurance Department for various health care services that are not covered in any fee schedule established by the Workers Compensation Board. Such periodic revisions to the various fee schedules have been promulgated by the Superintendent through amendments to Regulation 83. There have been twenty-nine amendments to Regulation 83.
The Workers' Compensation Board revised its fee schedules to utilize the American Medical Association's Current Procedural Terminology (CPT) coding effective on October 1, 1996. CPT coding is a nationally accepted billing standard that utilizes a 5 digit number to identify the medical procedure being performed and billed, and provides a description of the procedure and what the performance of that procedure entails.
It should be noted that although the general instructions and ground rules in the Workers Compensation Boards medical fee schedules apply to No-Fault claims, in accordance with the provisions of Regulation 83, those rules which refer to workers compensation claim forms, preauthorization approval, and dispute resolution guidelines do not apply to No-Fault claims.
The Official New York Workers' Compensation Medical Fee Schedule may be examined at the office of the Department of State, 162 Washington Ave., Albany, NY 12231, the Legislative Library, the libraries of the New York State Supreme Court, and the district offices of the Workers' Compensation Board in Albany, Binghamton, Brooklyn, Buffalo, Hauppauge, Hempstead, Manhattan, Peekskill, Queens, Rochester and Syracuse. Copies may be purchased from Ingenix, by writing to the New York Workers' Compensation Medical Fee Schedule, c/o Ingenix, PO Box 27116, Salt Lake City, UT 84127-0116, or by telephone at 1-877-464-3649.
The complete text of No-Fault Regulations 68 and 83 and No-Fault related frequently asked questions, as well as select opinions of the Departments Office of General Counsel applicable to No-Fault coverage may be found on the Department's web site at www.ins.state.ny.us/r68_link.htm.