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[Music] this video will provide you with important information regarding the board's adaptation of the CMS 1500 and its associated processes although the content of this training is intended for medical providers all of this information is relevant to those who will be using the CMS 1500 volunteer use of the CMS 1500 and the medical narrative is expected to begin after the first Clearinghouse is approved as an XML submission partner to start will provide an overview of this initiative next we will provide a list of the forms that are to be replaced with the CMS 1500 then we'll use the current doctors initial report form c4 to identify certain data locations within a CMS 1500 in addition to the CMS 1500 medical narratives will be required and we will outline the details you need to include in your medical narratives to wrap things up we'll discuss the form submission process and requirements and direct you to resources available to assist you in order to increase healthcare provider participation in the workers compensation system and improve injured workers access to timely quality medical care the Workers Compensation Board has made a strategic decision to adopt the CMS 1500 form providers have indicated that the unique paperwork requirements currently in the workers compensation system are time consuming to complete to reduce the administrative burden and increase provider participation the board will consolidate and eliminate certain medical billing forms and convert to the CMS 1500 form this is the universal claim form used by medical providers to build the Centers for Medicare and Medicaid Services CMS as well as health insurers careful review and discussion with various stakeholders confirmed that the CMS 1500 is easy to use and provides all the necessary information when combined with a medical narrative the board will replace the following forms with the CMS 1500 doctors initial report formed C 4 and EC for continuation to carrier employer billing section form C 4.1 doctors progress report forms C 4.2 and EC 4.2 ancillary medical report forms C for AMR and EC for AMR doctor's narrative report form EC for ner occupational physical therapists report forms ot PT 4 + EO t PT for psychologists report form ps4 ophthalmologists report form C 5 doctors report of maximum medical improvement permanent impairment form C 4.3 will not be changing during the voluntary phase the board is encouraging use of the new CMS 1500 and the medical narrative however the forms listed here will still be considered valid for billing submission let's go through the process of showing where the data from the doctor's initial report form c4 will be located on the CMS 1500 form on the board's website there are sample CMS 1500 forms available which label the specific field names we'll be using the doctor's initial report form c4 as an example to show where the information will be placed within the CMS 1500 this procedure is similar for all other forms listed on the CMS 1500 webpage let's start in section a item number one you will see the name field is labeled with field to transfer the name to field to within the CMS 1500 next field number 2 is the social security number as labeled this will now transfer to field 1a on the CMS 1500 field number 3 is the home phone number transfer this phone number to field number 5 on the CMS 1500 continue following the form guide to transfer your data on the doctor's initial report form c4 under Section a you will see that field numbers 10 and 11 are labeled as initial narrative report any fields labeled with initial narrative report should be included on your attached medical narrative if applicable rather than transfer to the CMS 1500 before we continue with the rest of the form we need to provide additional instruction for section 17 on the CMS 1500 although section 17 is not a specific field noted on the doctors initial report form C 4 it requires specific information on forms where it is noted the information in field 1717 a and 17 B should include the following information if applicable in order to ensure the acceptance of the CMS 1500 field 17 is where you input the name of referring provider or other source when billing for services rendered by an individual or entity and the service was performed under the supervision of an authorized physician or referred by an authorized physician or ordered by an authorized physician in field 1717 a and 17b the name of the physician their state license number and NPI number will be required additional technical detail including field requirements can be found on the board's website in the CMS 1500 field matrix filled 19 within the CMS 1500 also needs additional instruction you will see on page 1 of the doctor's initial report form see 4 under Section C form fields WCB authorization number and WCB rating code need to be transferred to field 19 on the CMS 1500 field 19 on the CMS 1500 will require specific pieces of information in order to ensure the acceptance of the CMS 1500 additional technical detail including field requirements can be found on the board's website in the CMS 1500 field matrix also referred to the Nu cc reference instruction manual July 2018 version continue transferring the data to their necessary filled boxes within the CMS 1500 to the next page peach - you'll follow the same procedure for placing the data as labeled on the CMS 1500 on page three of the doctor's initial report form c4 you will see most of the data will be pleased in the medical narrative page four of the forum also includes several fields to place in the medical narrative it is important to know that work status and temporary impairment and causation need to be placed at the top of the initial narrative report once you have finished with page for all of your data has been entered on the CMS 1500 and the narrative report on the CMS 1500 page on the board's website you will find other form details if you select the CMS 1500 requirements link you will find a list of other ceefor forms and their corresponding CMS 1500 fields we covered examples of fields within the doctor's initial report form see for that need to be included in the medical narrative rather than the CMS 1500 let's take a closer look at the initial narrative report and its requirements this should remain the standard practice for narrative reports per your field of medicine for example ophthalmologists are asked specific questions based on their specialty on the CMS 1500 webpage the CMS 1500 requirements link also contains the medical narrative requirements required for each type of narrative report we are now going to walk through the initial narrative report requirements for a physician when you submit a CMS 1500 in lieu of a C for form you must also submit a medical narrative when submitting a narrative it should be sent through a Clearing House who is an XML submission partner for a narrative report submitted by a physician for example details must include work status temporary impairment doctor's opinion or causation history of injury or illness objective findings diagnosis or assessment and a plan of care the first three listed work status temporary impairment and doctors opinion or causation should be provided at the beginning of the narrative report it is also important to remember that when adding your demographic information at the top of your narrative report to please include your rating number and authorization number example narrative reports are provided on the board's website on the first portion of the narrative report physicians must state the patient's work status by providing the following information has the patient missed work because of the injury or illness if yes provide the date the patient first missed work is the patient working if yes provide the date or dates the patient resumed limited work of any kind or resumed full work if the patient is not working can the patient return to usual work activities as indicated are there any work limitations if so explain and quantify including the anticipated duration of the limitations next physicians should add temporary impairment to their medical narrative this information should include what the percentage 0 to 100 percent of temporary impairment is and a description of the findings with an explanation of how the impairment percentage was determined the last portion of information that should be included at the top of a physician's narrative report is the doctor's opinion the doctor's opinion should include the following indicate if in your opinion the incident that the patient described was the competent medical cause of the injury or illness indicate if the patient's complaints are consistent with his or her history of the injury or illness indicate of the patient's history of the injury or illness is consistent with the objective findings or if it is not applicable at this time you next we'll take a look at some of the other types of attachments required based on your type of work in addition to the CMS 1500 and the medical narrative these are the additional requirements based on areas of medical specialty these do not reflect what is in the narrative that is also submitted for example the radiology medical bill should also contain a bill or invoice for service and a copy of the radiologic report this chart is also available on the CMS 1500 webpage for you to reference it is important to explain the distinction between a clearinghouse and an XML submission partner several clearinghouses are in the process of becoming board approved for XML submission once they are approved we refer to them as XML submission partners healthcare providers should partner with an approved XML submission partner or ensure that their Clearinghouse has a data sharing agreement with one the XML submission process is how an approved XML submission partner will submit CMS 1500s to the board why are we working with clearinghouses to become board approved XML submission partners because this process will allow providers to electronically submit medical bills and narratives to their Clearinghouse in the same manner they do today and for the board to electronically receive CMS 1500 data and forms in the required XML format this will include the CMS 1500 and applicable narratives and attachments the board is currently testing XML submissions with several clearinghouses some carriers may be asked to participate in a pilot with a Clearinghouse looking to become an XML submission partner the board's website has a list of current XML submission partners for you to view at any time navigate to the board's home page and search list of XML submission partners providers may be contacted by XML submission partners to assist with testing as we move forward with the CMS 1500 implementation we expect to bring on additional clearinghouses to become xml submission partners and continue growing this list if your Clearinghouse is not on the list as them to participate to learn more navigate to the board's homepage and search CMS 1500 where you can find more information including an overview of the initiative registration information sample documents and crosswalks from current forms it is important for providers to know that an electronic signature holds the same weed as a paper signature when using electronic submission an electronic submission still requires a signature every time an electronic process or symbol may constitute for signature of a party when attached to or associated with an electronic record and has been executed or adopted by a person with the intent to sign the record for more details see the New York State electronic signatures and Records Act II sra and the ESR a regulation implemented by the New York State Office for technology 9 NYC are our five four zero although the submission process may be changing the timeframes for medical report filing and bill submission are not medical report filing will continue to be at least 48 hours following the first treatment with a patient 15 days after the initial report is filed and subsequent progress reports at intervals are not to exceed 90 days also bills must continue to be submitted within 90 days from the last day of the month in which the services rendered or in which the claimant received final treatment in a continuous course of treatment once you send a bill a narrative report to an XML submission partner they will have up to seven business days to forward it to the payer and then to the board if the bill is rejected either by the payer or the board the XML submission partner must notify you it is the providers responsibility to make corrections to any rejected bills so that it can be resent to the payer and the board in a timely manner during fees one of this initiative the bill may be resent by paper are you currently submitting the EC for NER electronically to the board if yes you are already eligible to submit the CMS 1500 and medical narrative reports through your XML submission partner in a similar manner if you are unsure if you are eligible visit this webpage on your screen if your name is on this electronic eligibility list you have already gone through the steps to become eligible if your name is not on the electronic eligibility list you must execute a treating healthcare provider agreement for XML submission complete the board's XML registration by visiting the board's homepage at WCB NY gov selecting healthcare information and then selecting XML form submission at the bottom of this page after your information is submitted to the board's XML registration you will receive an email with the agreement to be signed and returned this email will provide detailed instructions on how you can submit the agreement thank you for viewing this presentation for more information visit the CMS 1500 webpage on the board's website if you have any questions please email CMS 1500 at WCB NY gov [Music]