SCHEDULE OF WORKER'S COMPENSATION / NO FAULT (WCNF)
INPATIENT CASE PAYMENT RATES ‐ EFFECTIVE 1/1/2011 ‐ 12/31/2011 (REVISED)
NYSDOH
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
DISCHARGE RATE
STATEWIDE PRICE
ISAF
HIGH COST CC's
IME %'s
DME RATE
CAPITAL RATE ‐ PER DISCH
CAPITAL RATE ‐ PER DIEM
ALC
WCNF SURCHARGES
ALC PRICE PER DAY
ADDITIONAL PUBLIC PUBLIC GOODS GOODS POOL POOL SURCHARGE
SURCHARGE
DISCHARGE CASE PAYMENT STATEWIDE INSTITUTION‐
HIGH COST RATE SPECIFIC BASE PRICE CHARGE (EXCLUDING (EXCLUDING PHL ADJUSTMENT CONVERTOR
§ 2807‐c(33)) FACTOR (ISAF)
PHL § 2807‐
c(33))
OPCERT
1623001
0101005
0101000
1624000
0701000
0501000
3801000
7002001
5501000
1427000
7001041
7002002
3535001
7000001
7001002
5123000
7001003
0601000
4429000
2238001
5263000
5401001
0901001
0824000
4401000
3421000
4720001
1001000
3301000
HOSPITAL NAME
ADIRONDACK MEDICAL CENTER
ALB MED CTR SO CLINICAL CAMP*
ALBANY MEDICAL CTR HOSP*
ALICE HYDE MEDICAL CENTER
ARNOT OGDEN MEDICAL CTR
AUBURN MEMORIAL HOSPITAL
AURELIA OSBORN FOX MEM HOSP
BELLEVUE HOSPITAL CENTER
BENEDICTINE HOSPITAL
BERTRAND CHAFFEE HOSPITAL
BETH ISRAEL / KINGS HIGHWAY
BETH ISRAEL MEDICAL CENTER
BON SECOURS COMMUNITY HOSP
BRONX‐LEBANON HOSPITAL CTR
BROOKDALE HOSPITAL MED CTR
BROOKHAVEN MEMORIAL HOSP
BROOKLYN HOSPITAL
BROOKS MEMORIAL HOSPITAL
CANTON‐POTSDAM HOSPITAL
CARTHAGE AREA HOSPITAL INC
CATSKILL REGIONAL MED CTR
CAYUGA MEDICAL CENTER
CHAMPLAIN VALLEY PHYS
CHENANGO MEMORIAL HOSP
CLAXTON‐HEPBURN MED CTR
CLIFTON SPRINGS HOSPITAL
COBLESKILL REGIONAL HOSP
COLUMBIA MEMORIAL HOSPITAL
COMM‐GEN / GREATER SYRACUSE
6/20/2012
$5,669.82
$6,045.65
$7,186.77
$5,543.09
$5,532.76
$5,938.44
$5,461.82
$8,892.49
$6,135.68
$4,815.08
$8,041.41
$9,681.49
$6,319.32
$9,323.52
$8,718.36
$7,144.73
$8,548.69
$5,044.43
$5,464.57
$5,060.96
$6,301.41
$6,069.30
$5,787.60
$5,248.31
$5,297.90
$4,785.46
$5,237.29
$5,651.23
$6,491.00
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
0.8232
0.8436
0.8699
0.8048
0.8033
0.8622
0.7930
1.0233
0.8726
0.6991
1.1652
1.1304
0.9175
1.0648
1.0476
1.0183
1.0296
0.7324
0.7934
0.7348
0.9149
0.8812
0.8403
0.7620
0.7692
0.6948
0.7604
0.8205
0.9264
CAPITAL PER DISCHARGE PLUS NON‐COMPARABLES: INDIRECT DIRECT AMBULANCE, SCHOOL OF MEDICAL MEDICAL NURSING & TEACHING CAPITAL PER DIEM
EDUCATION EDUCATION ELECTION AMENDMENT (IME) %
(DME) ADD‐ON
PHYS ADD‐ONS (Excludes Transition Add‐ons)
0.633439
0.788103
0.392027
0.573986
0.468437
0.491137
0.668487
0.790023
0.312028
0.602722
0.185338
0.335516
0.309085
0.730071
0.584224
0.209413
0.543652
0.697443
0.600233
0.440857
0.436770
0.759452
0.439962
0.501189
0.665019
0.583462
0.920860
0.462135
0.534457
0.00%
4.05%
19.95%
0.00%
0.00%
0.00%
0.00%
26.17%
2.09%
0.00%
0.20%
24.35%
0.00%
27.13%
20.83%
1.87%
20.55%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
1.73%
1 of 7
$0.00
$42.40
$614.22
$0.00
$0.00
$0.00
$0.00
$2,513.24
$85.37
$0.00
$625.66
$1,181.06
$0.00
$2,096.94
$1,360.95
$0.00
$634.13
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$26.90
**(PER DISCH)**
$395.76
$2,901.20
$723.78
$300.11
$447.52
$446.28
$226.29
$1,844.41
$829.97
$143.11
$159.85
$770.66
$290.46
$507.61
$383.94
$322.74
$403.96
$222.37
$342.20
$142.22
$351.55
$387.13
$604.61
$198.45
$215.81
$230.81
$471.14
$339.23
$314.39
**(PER DAY**)
$86.11
$1,426.82
$128.61
$74.13
$88.49
$105.38
$52.68
$151.24
$148.19
$41.97
$26.88
$158.53
$67.67
$82.76
$69.99
$61.18
$78.35
$53.34
$106.73
$34.26
$90.54
$99.72
$103.69
$47.01
$52.08
$40.56
$55.70
$78.91
$67.53
$176.41
$176.41
$176.41
$176.41
$176.41
$176.41
$176.41
$268.30
$176.41
$176.41
$268.30
$268.30
$176.41
$268.30
$268.30
$268.30
$268.30
$176.41
$176.41
$176.41
$176.41
$176.41
$176.41
$176.41
$176.41
$176.41
$176.41
$176.41
$176.41
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
(11)
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
pub_ip_jan2011_wcnf_rev_01_10_12_rev_6‐19‐12.xls
Ref 030
SCHEDULE OF WORKER'S COMPENSATION / NO FAULT (WCNF)
INPATIENT CASE PAYMENT RATES ‐ EFFECTIVE 1/1/2011 ‐ 12/31/2011 (REVISED)
NYSDOH
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
DISCHARGE RATE
STATEWIDE PRICE
ISAF
HIGH COST CC's
IME %'s
DME RATE
CAPITAL RATE ‐ PER DISCH
CAPITAL RATE ‐ PER DIEM
ALC
WCNF SURCHARGES
ALC PRICE PER DAY
ADDITIONAL PUBLIC PUBLIC GOODS GOODS POOL POOL SURCHARGE
SURCHARGE
DISCHARGE CASE PAYMENT STATEWIDE INSTITUTION‐
HIGH COST RATE SPECIFIC BASE PRICE CHARGE (EXCLUDING (EXCLUDING PHL ADJUSTMENT CONVERTOR
§ 2807‐c(33)) FACTOR (ISAF)
PHL § 2807‐
c(33))
OPCERT
2625000
7001009
5001000
1101000
3301008
4423000
5127000
3101000
4601001
7003000
1401005
3429000
3202003
7003001
7003013
2910000
3402000
2901000
5601000
4329000
5154001
7002009
2701001
7002012
5901000
5153000
7001046
5022000
7000002
HOSPITAL NAME
COMMUNITY MEMORIAL HOSPITAL
CONEY ISLAND HOSPITAL
CORNING HOSPITAL
CORTLAND REGIONAL MED CTR
CROUSE HOSPITAL
E J NOBLE HOSP / GOUVERNEUR
EASTERN LONG ISLAND HOSPITAL
EASTERN NIAGARA HOSPITAL
ELLIS HOSPITAL*
ELMHURST HOSPITAL CTR
ERIE COUNTY MEDICAL CENTER*
F F THOMPSON HOSPITAL
FAXTON‐ST LUKES HEALTHCARE
FLUSHING HOSPITAL
FOREST HILLS HOSPITAL
FRANKLIN HOSPITAL
GENEVA GENERAL HOSPITAL
GLEN COVE HOSPITAL
GLENS FALLS HOSPITAL
GOOD SAMARITAN / SUFFERN
GOOD SAMARITAN / WEST ISLIP
HARLEM HOSPITAL CENTER
HIGHLAND HOSP OF ROCHESTER
HOSPITAL FOR SPECIAL SURGERY
HUDSON VALLEY HOSPITAL CTR
HUNTINGTON HOSPITAL
INTERFAITH MEDICAL CENTER
IRA DAVENPORT MEMORIAL HOSP
JACOBI MEDICAL CENTER
6/20/2012
$5,540.34
$8,140.79
$6,045.88
$5,530.69
$6,854.93
$4,715.90
$6,821.42
$5,567.20
$6,086.52
$9,075.81
$7,725.38
$4,857.78
$5,759.94
$8,386.45
$8,344.48
$6,864.54
$5,025.84
$8,093.42
$5,611.97
$7,052.15
$7,373.20
$9,496.41
$6,539.73
$9,821.20
$6,587.24
$7,342.40
$9,510.28
$5,187.70
$9,726.17
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
0.8044
1.0110
0.8778
0.8030
0.9458
0.6847
0.9904
0.8083
0.8401
1.0763
0.9218
0.7053
0.8308
1.0332
1.1309
0.9829
0.7297
1.1288
0.8148
1.0239
1.0148
1.0509
0.8599
1.1809
0.9564
1.0580
1.0538
0.7532
1.1093
CAPITAL PER DISCHARGE PLUS NON‐COMPARABLES: INDIRECT DIRECT AMBULANCE, SCHOOL OF MEDICAL MEDICAL NURSING & TEACHING CAPITAL PER DIEM
EDUCATION EDUCATION ELECTION AMENDMENT (IME) %
(DME) ADD‐ON
PHYS ADD‐ONS (Excludes Transition Add‐ons)
0.533932
0.680783
0.567279
0.684025
0.556811
0.595681
0.416567
0.599802
0.293822
0.574950
0.483063
0.573882
0.481342
0.529894
0.397327
0.288633
0.610428
0.348526
0.516468
0.198706
0.250920
1.002754
0.610190
0.380113
0.297442
0.319587
0.311264
0.571873
0.786295
0.00%
16.91%
0.00%
0.00%
5.23%
0.00%
0.00%
0.00%
5.19%
22.43%
21.68%
0.00%
0.66%
17.85%
7.13%
1.40%
0.00%
4.10%
0.00%
0.00%
5.49%
31.20%
10.42%
20.75%
0.00%
0.76%
31.03%
0.00%
27.30%
2 of 7
$0.00
$1,215.76
$0.00
$0.00
$133.37
$0.00
$0.00
$0.00
$20.49
$1,258.21
$572.90
$0.00
$0.14
$680.36
$128.10
$211.94
$0.00
$134.21
$0.00
$0.00
$221.03
$2,821.95
$106.30
$1,601.39
$0.00
$12.68
$904.74
$0.00
$2,047.29
**(PER DISCH)**
$204.89
$3,768.35
$133.26
$409.37
$568.81
$195.07
$960.42
$183.21
$435.24
$2,097.58
$619.63
$345.38
$301.79
$589.16
$447.10
$327.66
$304.93
$546.97
$449.28
$467.18
$300.82
$1,875.58
$296.07
$1,530.79
$421.37
$477.25
$894.37
$116.09
$2,690.67
**(PER DAY**)
$53.30
$128.48
$42.49
$53.96
$102.41
$39.32
$213.24
$41.29
$91.29
$136.68
$96.39
$87.52
$63.67
$51.38
$92.93
$59.08
$59.63
$96.33
$99.67
$111.30
$60.32
$107.24
$69.85
$384.55
$89.01
$105.20
$126.15
$30.38
$192.62
$176.41
$268.30
$176.41
$176.41
$176.41
$176.41
$268.30
$176.41
$176.41
$268.30
$176.41
$176.41
$176.41
$268.30
$268.30
$268.30
$176.41
$268.30
$176.41
$268.30
$268.30
$268.30
$176.41
$268.30
$268.30
$268.30
$268.30
$176.41
$268.30
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
(11)
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
pub_ip_jan2011_wcnf_rev_01_10_12_rev_6‐19‐12.xls
Ref 030
SCHEDULE OF WORKER'S COMPENSATION / NO FAULT (WCNF)
INPATIENT CASE PAYMENT RATES ‐ EFFECTIVE 1/1/2011 ‐ 12/31/2011 (REVISED)
NYSDOH
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
DISCHARGE RATE
STATEWIDE PRICE
ISAF
HIGH COST CC's
IME %'s
DME RATE
CAPITAL RATE ‐ PER DISCH
CAPITAL RATE ‐ PER DIEM
ALC
WCNF SURCHARGES
ALC PRICE PER DAY
ADDITIONAL PUBLIC PUBLIC GOODS GOODS POOL POOL SURCHARGE
SURCHARGE
DISCHARGE CASE PAYMENT STATEWIDE INSTITUTION‐
HIGH COST RATE SPECIFIC BASE PRICE CHARGE (EXCLUDING (EXCLUDING PHL ADJUSTMENT CONVERTOR
§ 2807‐c(33)) FACTOR (ISAF)
PHL § 2807‐
c(33))
OPCERT
7003003
5149000
0228000
1401014
1401014
1401002
1404000
7001016
7001033
5501001
2728001
5922000
7002017
2424000
7000008
2902000
7001017
7003004
7001019
7001020
3824000
4402000
3622000
0101003
1401008
2909000
7002021
7000006
7003015
HOSPITAL NAME
JAMAICA HOSPITAL
JOHN T MATHER MEMORIAL HOSP
JONES MEMORIAL HOSPITAL
KALEIDA HEALTH
KALEIDA HEALTH (MILLARD)
KALEIDA HLTH/WOMAN&CHILDRENS
KENMORE MERCY HOSPITAL
KINGS COUNTY HOSPITAL CENTER
KINGSBROOK JEWISH MED CTR
KINGSTON HOSPITAL
LAKESIDE MEMORIAL HOSPITAL
LAWRENCE HOSPITAL
LENOX HILL HOSPITAL
LEWIS COUNTY GENERAL HOSP
LINCOLN MEDICAL
LONG BEACH MEDICAL CENTER
LONG ISLAND COLLEGE HOSPITAL*
LONG ISLAND JEWISH
LUTHERAN MEDICAL CENTER
MAIMONIDES MEDICAL CENTER
MARY IMOGENE BASSETT HOSP
MASSENA MEMORIAL HOSPITAL
MEDINA MEMORIAL HOSPITAL
MEMORIAL HOSP OF ALBANY
MERCY HOSPITAL OF BUFFALO
MERCY MEDICAL CENTER
METROPOLITAN HOSPITAL CENTER
MONTEFIORE MEDICAL CENTER
MOUNT SINAI HOSP OF QUEENS*
6/20/2012
$8,994.98
$7,084.52
$5,116.06
$7,176.36
$7,176.36
$7,970.80
$5,642.96
$9,324.70
$9,061.30
$6,334.41
$5,007.93
$6,869.63
$8,265.98
$5,622.30
$8,844.56
$6,907.61
$8,739.55
$9,670.07
$8,687.45
$10,096.98
$5,864.17
$5,537.58
$4,455.55
$5,552.73
$6,271.86
$7,023.57
$8,995.74
$9,973.79
$10,255.92
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
1.1241
1.0286
0.7428
0.9274
0.9274
0.9147
0.8193
1.0145
1.1482
0.8734
0.7271
0.9974
1.0407
0.8163
1.0321
0.9032
1.0333
1.0882
1.0172
1.1904
0.7538
0.8040
0.6469
0.8062
0.8840
1.0167
1.0211
1.1229
1.1206
CAPITAL PER DISCHARGE PLUS NON‐COMPARABLES: INDIRECT DIRECT AMBULANCE, SCHOOL OF MEDICAL MEDICAL NURSING & TEACHING CAPITAL PER DIEM
EDUCATION EDUCATION ELECTION AMENDMENT (IME) %
(DME) ADD‐ON
PHYS ADD‐ONS (Excludes Transition Add‐ons)
0.600097
0.355978
0.590215
0.432257
0.432257
0.423450
0.435233
0.723330
0.336873
0.462225
0.424993
0.381174
0.212152
0.701273
0.868774
0.305201
0.409851
0.318139
0.579842
0.313754
0.496744
0.632200
0.865467
0.530937
0.461137
0.316249
0.781170
0.277820
0.388988
16.18%
0.00%
0.00%
12.35%
12.35%
26.52%
0.00%
33.45%
14.58%
5.30%
0.00%
0.00%
15.32%
0.00%
24.42%
11.04%
22.80%
29.02%
24.00%
23.15%
12.95%
0.00%
0.00%
0.00%
3.01%
0.30%
27.91%
28.96%
32.88%
3 of 7
$716.59
$0.00
$0.00
$313.40
$313.40
$372.22
$0.00
$2,482.51
$1,126.30
$226.20
$0.00
$0.00
$1,110.65
$0.00
$1,207.94
$437.70
$1,030.71
$1,073.18
$991.72
$1,038.42
$367.03
$0.00
$0.00
$0.00
$46.91
$58.07
$1,973.65
$2,554.35
$1,295.36
**(PER DISCH)**
$554.93
$351.83
$419.53
$706.61
$706.61
$367.52
$499.81
$2,570.12
$410.43
$232.56
$118.86
$448.41
$977.05
$373.44
$2,668.76
$422.58
$1,107.53
$685.72
$485.68
$838.24
$325.12
$284.47
$0.00
$599.17
$485.01
$488.88
$1,362.14
$671.55
$396.65
**(PER DAY**)
$52.30
$63.21
$119.09
$149.32
$149.32
$83.61
$84.85
$223.23
$68.13
$54.88
$34.82
$100.84
$167.38
$98.45
$103.24
$63.54
$200.24
$146.82
$56.24
$148.36
$72.44
$78.22
$0.00
$88.04
$99.87
$97.31
$147.10
$128.78
$72.78
$268.30
$268.30
$176.41
$176.41
$176.41
$176.41
$176.41
$268.30
$268.30
$176.41
$176.41
$268.30
$268.30
$176.41
$268.30
$268.30
$268.30
$268.30
$268.30
$268.30
$176.41
$176.41
$176.41
$176.41
$176.41
$268.30
$268.30
$268.30
$268.30
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
(11)
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
pub_ip_jan2011_wcnf_rev_01_10_12_rev_6‐19‐12.xls
Ref 030
SCHEDULE OF WORKER'S COMPENSATION / NO FAULT (WCNF)
INPATIENT CASE PAYMENT RATES ‐ EFFECTIVE 1/1/2011 ‐ 12/31/2011 (REVISED)
NYSDOH
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
DISCHARGE RATE
STATEWIDE PRICE
ISAF
HIGH COST CC's
IME %'s
DME RATE
CAPITAL RATE ‐ PER DISCH
CAPITAL RATE ‐ PER DIEM
ALC
WCNF SURCHARGES
ALC PRICE PER DAY
ADDITIONAL PUBLIC PUBLIC GOODS GOODS POOL POOL SURCHARGE
SURCHARGE
DISCHARGE CASE PAYMENT STATEWIDE INSTITUTION‐
HIGH COST RATE SPECIFIC BASE PRICE CHARGE (EXCLUDING (EXCLUDING PHL ADJUSTMENT CONVERTOR
§ 2807‐c(33)) FACTOR (ISAF)
PHL § 2807‐
c(33))
OPCERT
7002024
3121001
5903000
2950002
1701000
7002000
3102000
2527000
7000024
2951001
1327000
5920000
7001008
7002026
7003010
7001021
7002054
7002054
7002054
7000025
4324000
7002053
7002053
0401001
2601001
3523000
3702000
0301001
HOSPITAL NAME
MOUNT SINAI HOSPITAL
MOUNT ST MARYS HOSPITAL
MOUNT VERNON HOSPITAL
NASSAU UNIV MED CTR
NATHAN LITTAUER HOSPITAL
NEW YORK DOWNTOWN HOSP
NIAGARA FALLS MEMORIAL
NICHOLAS H NOYES MEMORIAL
NORTH CENTRAL BRONX HOSPITAL
NORTH SHORE UNIVERSITY HOSP
NORTHERN DUTCHESS HOSPITAL
NORTHERN WESTCHESTER HOSP
NY COMMUNITY / BROOKLYN
NY EYE AND EAR INFIRMARY
NY MED CTR OF QUEENS
NY METHODIST HOSP / BROOKLYN
NY PRESBYTERIAN HOSPITAL
NY PRESBYTERIAN HOSPITAL (ALLEN)
NY PRESBYTERIAN HOSPITAL (PRESBY)
NY WESTCHESTER SQUARE MED CTR
NYACK HOSPITAL
NYU HOSPITALS CENTER
NYU HOSPITALS CENTER/HOSP FOR JOINT DIS
OLEAN GENERAL HOSPITAL
ONEIDA HEALTHCARE CENTER
ORANGE REGIONAL MED CTR
OSWEGO HOSPITAL
OUR LADY OF LOURDES MEMORIAL
6/20/2012
CAPITAL PER DISCHARGE PLUS NON‐COMPARABLES: INDIRECT DIRECT AMBULANCE, SCHOOL OF MEDICAL MEDICAL NURSING & TEACHING CAPITAL PER DIEM
EDUCATION EDUCATION ELECTION AMENDMENT (IME) %
(DME) ADD‐ON
PHYS ADD‐ONS (Excludes Transition Add‐ons)
(11)
$10,255.92
$5,850.97
$7,959.56
$9,490.37
$5,354.37
$8,625.82
$5,572.27
$5,104.36
$8,868.55
$9,296.66
$6,574.85
$6,967.44
$7,664.45
$8,168.55
$8,821.39
$8,592.63
$9,787.46
$9,787.46
$9,787.46
$6,878.59
$6,715.35
$8,828.22
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
1.1206
0.8495
1.0550
1.1324
0.7774
1.0608
0.7768
0.7411
1.1408
1.1617
0.9546
1.0116
1.1128
1.0217
1.0990
1.0683
1.1184
1.1184
1.1184
0.9987
0.9750
1.0701
0.423808
0.550469
0.560216
0.628195
0.534222
0.540329
0.490218
0.464593
0.755691
0.293430
0.411690
0.535071
0.421484
0.420274
0.379023
0.471205
0.385719
0.385719
0.385719
0.400254
0.274764
0.393229
32.88%
0.00%
9.54%
21.68%
0.00%
18.06%
4.15%
0.00%
12.87%
16.19%
0.00%
0.00%
0.00%
16.08%
16.54%
16.78%
27.06%
27.06%
27.06%
0.00%
0.00%
19.78%
$1,295.36
$0.00
$1,016.87
$872.03
$0.00
$695.54
$82.22
$0.00
$1,320.70
$1,245.20
$0.00
$0.00
$0.00
$2,320.59
$769.20
$810.93
$1,389.12
$1,389.12
$1,389.12
$0.00
$0.00
$1,882.82
**(PER DISCH)**
$819.15
$233.47
$567.21
$519.23
$289.40
$746.05
$428.11
$275.53
$1,032.96
$1,236.92
$331.32
$517.97
$272.22
$333.57
$927.02
$342.64
$1,760.39
$1,760.39
$1,760.39
$198.03
$239.51
$1,437.81
**(PER DAY**)
$166.36
$57.04
$38.71
$92.47
$73.42
$142.61
$95.65
$73.88
$111.13
$155.65
$90.58
$130.50
$43.88
$155.14
$149.38
$72.72
$257.30
$257.30
$257.30
$29.16
$57.38
$306.04
$268.30
$176.41
$268.30
$268.30
$176.41
$268.30
$176.41
$176.41
$268.30
$268.30
$176.41
$268.30
$268.30
$268.30
$268.30
$268.30
$268.30
$268.30
$268.30
$268.30
$268.30
$268.30
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
$8,828.22
$5,290.32
$4,987.96
$6,858.61
$5,667.76
$5,662.67
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
1.0701
0.7681
0.7242
0.9958
0.8229
0.8047
0.393229
0.513318
0.503143
0.260719
0.567339
0.532027
19.78%
0.00%
0.00%
0.00%
0.00%
2.17%
$1,882.82
$0.00
$0.00
$0.00
$0.00
$5.33
$1,437.81
$377.16
$509.71
$623.67
$568.59
$239.28
$306.04
$83.37
$126.98
$144.92
$118.58
$60.75
$268.30
$176.41
$176.41
$176.41
$176.41
$176.41
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
4 of 7
pub_ip_jan2011_wcnf_rev_01_10_12_rev_6‐19‐12.xls
Ref 030
SCHEDULE OF WORKER'S COMPENSATION / NO FAULT (WCNF)
INPATIENT CASE PAYMENT RATES ‐ EFFECTIVE 1/1/2011 ‐ 12/31/2011 (REVISED)
NYSDOH
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
DISCHARGE RATE
STATEWIDE PRICE
ISAF
HIGH COST CC's
IME %'s
DME RATE
CAPITAL RATE ‐ PER DISCH
CAPITAL RATE ‐ PER DIEM
ALC
WCNF SURCHARGES
ALC PRICE PER DAY
ADDITIONAL PUBLIC PUBLIC GOODS GOODS POOL POOL SURCHARGE
SURCHARGE
DISCHARGE CASE PAYMENT STATEWIDE INSTITUTION‐
HIGH COST RATE SPECIFIC BASE PRICE CHARGE (EXCLUDING (EXCLUDING PHL ADJUSTMENT CONVERTOR
§ 2807‐c(33)) FACTOR (ISAF)
PHL § 2807‐
c(33))
OPCERT
5155000
7003006
5932000
2952005
3950000
7003007
7004010
2701003
3201002
4102002
2201000
4501000
4102003
1401006
1401013
5904000
2950001
5126000
5154000
3529000
7000014
5157003
5149001
3202002
1302000
2953000
5002001
7001024
5907001
HOSPITAL NAME
PECONIC BAY MED CTR
PENINSULA HOSPITAL CENTER
PHELPS MEMORIAL HOSP
PLAINVIEW HOSPITAL
PUTNAM COMMUNITY HOSPITAL
QUEENS HOSPITAL CENTER
RICHMOND UNIV MED CTR
ROCHESTER GENERAL HOSPITAL
ROME HOSPITAL AND MURPHY
SAMARITAN HOSPITAL OF TROY
SAMARITAN MEDICAL CENTER
SARATOGA HOSPITAL
SETON HEALTH SYSTEMS
SHEEHAN MEMORIAL EMERGENCY
SISTERS OF CHARITY HOSPITAL
SOUND SHORE MEDICAL CENTER
SOUTH NASSAU COMMUNITIES
SOUTHAMPTON HOSPITAL
SOUTHSIDE HOSPITAL
ST ANTHONY COMMUNITY HOSP
ST BARNABAS HOSPITAL
ST CATHERINE OF SIENA
ST CHARLES HOSPITAL
ST ELIZABETH MEDICAL CENTER
ST FRANCIS HOSP / POUGH
ST FRANCIS HOSP / ROSLYN
ST JAMES MERCY HOSPITAL
ST JOHNS EPISCOPAL SO SHORE
ST JOHNS RIVERSIDE HOSPITAL
6/20/2012
$6,888.92
$7,187.16
$6,887.54
$7,916.23
$7,064.55
$9,258.79
$7,940.43
$6,437.71
$5,308.23
$5,476.28
$5,871.67
$5,731.81
$5,543.09
$5,047.88
$5,933.91
$7,859.30
$6,860.97
$7,241.78
$7,554.51
$6,586.55
$8,931.23
$7,286.33
$6,708.31
$6,110.49
$5,950.83
$7,377.52
$4,552.66
$10,304.21
$6,684.36
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
1.0002
0.9395
1.0000
1.1043
1.0257
1.1398
0.9998
0.8491
0.7707
0.7951
0.8444
0.8322
0.8048
0.7329
0.8265
1.0294
0.9632
1.0076
1.0468
0.9563
1.0267
1.0579
0.9651
0.8391
0.8640
1.0656
0.6610
1.1937
0.9705
CAPITAL PER DISCHARGE PLUS NON‐COMPARABLES: INDIRECT DIRECT AMBULANCE, SCHOOL OF MEDICAL MEDICAL NURSING & TEACHING CAPITAL PER DIEM
EDUCATION EDUCATION ELECTION AMENDMENT (IME) %
(DME) ADD‐ON
PHYS ADD‐ONS (Excludes Transition Add‐ons)
0.240950
0.374040
0.372063
0.342136
0.322529
0.807393
0.279179
0.485187
0.478620
0.443743
0.535569
0.388246
0.355218
0.695993
0.475144
0.538128
0.288378
0.412366
0.337697
0.262404
0.262966
0.266765
0.313916
0.481391
0.318707
0.332146
0.501685
0.504795
0.423654
0.00%
11.07%
0.00%
4.08%
0.00%
17.94%
15.31%
10.08%
0.00%
0.00%
0.96%
0.00%
0.00%
0.00%
4.24%
10.85%
3.42%
4.35%
4.78%
0.00%
26.30%
0.00%
0.92%
5.73%
0.00%
0.52%
0.00%
25.33%
0.00%
5 of 7
$0.00
$394.69
$0.00
$155.84
$0.00
$1,055.54
$470.65
$218.16
$0.00
$0.00
$25.25
$0.00
$0.00
$0.00
$138.34
$651.59
$109.91
$0.00
$151.80
$0.00
$1,088.45
$0.00
$79.52
$121.61
$0.00
$194.94
$0.00
$767.89
$0.00
**(PER DISCH)**
$845.68
$171.70
$714.00
$351.80
$502.13
$1,517.52
$616.56
$517.73
$279.85
$452.66
$376.59
$515.80
$273.75
$0.00
$399.34
$281.14
$529.58
$583.88
$543.78
$412.06
$540.85
$295.16
$279.60
$583.95
$866.74
$1,041.21
$298.85
$245.72
$346.11
**(PER DAY**)
$204.31
$23.81
$160.28
$69.05
$108.50
$148.33
$58.15
$103.10
$68.10
$81.77
$77.24
$99.35
$61.66
$0.00
$75.22
$60.54
$100.02
$170.38
$126.79
$101.73
$124.67
$56.21
$67.96
$89.06
$188.47
$181.50
$90.03
$40.54
$47.75
$268.30
$268.30
$268.30
$268.30
$176.41
$268.30
$268.30
$176.41
$176.41
$176.41
$176.41
$176.41
$176.41
$176.41
$176.41
$268.30
$268.30
$268.30
$268.30
$176.41
$268.30
$268.30
$268.30
$176.41
$176.41
$268.30
$176.41
$268.30
$268.30
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
(11)
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
pub_ip_jan2011_wcnf_rev_01_10_12_rev_6‐19‐12.xls
Ref 030
SCHEDULE OF WORKER'S COMPENSATION / NO FAULT (WCNF)
INPATIENT CASE PAYMENT RATES ‐ EFFECTIVE 1/1/2011 ‐ 12/31/2011 (REVISED)
NYSDOH
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
DISCHARGE RATE
STATEWIDE PRICE
ISAF
HIGH COST CC's
IME %'s
DME RATE
CAPITAL RATE ‐ PER DISCH
CAPITAL RATE ‐ PER DIEM
ALC
WCNF SURCHARGES
ALC PRICE PER DAY
ADDITIONAL PUBLIC PUBLIC GOODS GOODS POOL POOL SURCHARGE
SURCHARGE
DISCHARGE CASE PAYMENT STATEWIDE INSTITUTION‐
HIGH COST RATE SPECIFIC BASE PRICE CHARGE (EXCLUDING (EXCLUDING PHL ADJUSTMENT CONVERTOR
§ 2807‐c(33)) FACTOR (ISAF)
PHL § 2807‐
c(33))
OPCERT
2952006
0701001
3301003
5907002
7002032
3522000
2801001
0101004
7001037
7004003
2701005
2754001
0427000
1227001
0303001
1801000
5151001
3301007
1302001
5820000
5957001
0632000
5902001
2908000
0602001
7001045
7001035
6027000
HOSPITAL NAME
ST JOSEPH HOSPITAL (formerly NEW ISLAND HOSP)
ST JOSEPHS HOSP / ELMIRA
ST JOSEPHS HOSP HLTH CTR
ST JOSEPHS HOSPITAL YONKERS*
ST LUKES / ROOSEVELT HOSP
ST LUKES CORNWALL
ST MARYS HOSP / AMSTERDAM
ST PETERS HOSPITAL
STATE UNIV HOSP / DOWNSTATE
STATEN ISLAND UNIV HOSP
STRONG MEMORIAL HOSPITAL
THE UNITY HOSPITAL
TLC HEALTH NETWORK
TRI‐TOWN REGIONAL HEALTHCARE
UNITED HEALTH SERVICES INC
UNITED MEMORIAL MED CTR
UNIV HOSP AT STONY BROOK
UNIV HOSP SUNY HLTH SCI CTR
VASSAR BROTHERS MED CTR
WAYNE HEALTH CARE
WESTCHESTER MEDICAL CENTER
WESTFIELD MEMORIAL HOSP
WHITE PLAINS HOSPITAL
WINTHROP UNIVERSITY HOSPITAL
WOMANS CHRISTIAN ASSOC
WOODHULL MEDICAL
WYCKOFF HEIGHTS HOSPITAL
WYOMING CO COMMUNITY HOSP
6/20/2012
CAPITAL PER DISCHARGE PLUS NON‐COMPARABLES: INDIRECT DIRECT AMBULANCE, SCHOOL OF MEDICAL MEDICAL NURSING & TEACHING CAPITAL PER DIEM
EDUCATION EDUCATION ELECTION AMENDMENT (IME) %
(DME) ADD‐ON
PHYS ADD‐ONS (Excludes Transition Add‐ons)
**(PER DISCH)**
$6,952.97
$5,116.75
$6,418.72
$7,218.29
$10,445.19
$6,215.32
$5,204.23
$6,105.26
$9,433.35
$8,222.19
$7,994.12
$5,747.67
$4,700.06
$6,887.54
$6,283.40
$5,266.90
$9,094.20
$8,161.82
$6,834.51
$5,326.82
$9,301.80
$4,955.59
$7,046.64
$8,174.84
$5,107.80
$8,460.14
$8,523.82
$5,344.04
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
$6,887.54
1.0095
0.7429
0.8836
0.9703
1.2181
0.9024
0.7556
0.8670
1.0909
1.0178
0.8996
0.7752
0.6824
1.0000
0.8484
0.7647
1.0257
0.9184
0.9923
0.7734
1.1393
0.7195
1.0231
1.0188
0.7416
1.0175
1.0677
0.7759
0.341489
0.479156
0.459105
0.582145
0.331090
0.241413
0.518524
0.349021
0.743965
0.350479
0.571813
0.563002
0.594185
1.000000
0.529650
0.513022
0.433128
0.577036
0.307627
0.485046
0.342782
0.884032
0.460502
0.300934
0.469819
0.933577
0.509478
0.942083
0.00%
0.00%
5.47%
8.01%
24.50%
0.00%
0.00%
2.24%
25.55%
17.29%
29.02%
7.65%
0.00%
0.00%
7.53%
0.00%
28.73%
29.03%
0.00%
0.00%
18.54%
0.00%
0.00%
16.50%
0.00%
20.72%
15.91%
0.00%
6 of 7
$15.55
$0.00
$49.22
$255.05
$1,338.09
$0.00
$0.00
$58.93
$1,955.94
$526.30
$736.67
$48.01
$0.00
$0.00
$207.38
$0.00
$1,094.73
$1,047.67
$0.00
$0.00
$1,909.00
$0.00
$0.00
$711.04
$0.00
$1,726.00
$988.35
$0.00
$302.47
$205.18
$477.31
$613.49
$1,103.39
$466.21
$194.19
$619.02
$889.10
$425.48
$704.80
$471.94
$175.76
$415.00
$328.34
$425.46
$1,214.24
$739.65
$452.40
$310.32
$1,797.23
$150.45
$419.56
$730.86
$228.65
$3,303.69
$472.64
$194.95
(11)
**(PER DAY**)
$57.21
$37.92
$71.38
$113.35
$220.74
$104.10
$46.67
$132.94
$159.21
$49.13
$122.76
$100.76
$39.19
$207.50
$65.81
$101.39
$176.98
$127.05
$98.68
$76.99
$245.38
$50.15
$81.89
$154.09
$51.26
$134.30
$98.20
$40.11
$268.30
$176.41
$176.41
$268.30
$268.30
$176.41
$176.41
$176.41
$268.30
$268.30
$176.41
$176.41
$176.41
$176.41
$176.41
$176.41
$268.30
$176.41
$176.41
$176.41
$268.30
$176.41
$268.30
$268.30
$176.41
$268.30
$268.30
$176.41
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
pub_ip_jan2011_wcnf_rev_01_10_12_rev_6‐19‐12.xls
Ref 030
SCHEDULE OF WORKER'S COMPENSATION / NO FAULT (WCNF)
INPATIENT CASE PAYMENT RATES ‐ EFFECTIVE 1/1/2011 ‐ 12/31/2011 (REVISED)
NYSDOH
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
DISCHARGE RATE
STATEWIDE PRICE
ISAF
HIGH COST CC's
IME %'s
DME RATE
CAPITAL RATE ‐ PER DISCH
CAPITAL RATE ‐ PER DIEM
ALC
WCNF SURCHARGES
ALC PRICE PER DAY
ADDITIONAL PUBLIC PUBLIC GOODS GOODS POOL POOL SURCHARGE
SURCHARGE
DISCHARGE CASE PAYMENT STATEWIDE INSTITUTION‐
HIGH COST RATE SPECIFIC BASE PRICE CHARGE (EXCLUDING (EXCLUDING PHL ADJUSTMENT CONVERTOR
§ 2807‐c(33)) FACTOR (ISAF)
PHL § 2807‐
c(33))
OPCERT
HOSPITAL NAME
6/20/2012
CAPITAL PER DISCHARGE PLUS NON‐COMPARABLES: INDIRECT DIRECT AMBULANCE, SCHOOL OF MEDICAL MEDICAL NURSING & TEACHING CAPITAL PER DIEM
EDUCATION EDUCATION ELECTION AMENDMENT (IME) %
(DME) ADD‐ON
PHYS ADD‐ONS (Excludes Transition Add‐ons)
**(PER DISCH)**
Note: Effective 1/1/2011, Maimonides Capital per Discharge rate no longer includes a High Cost Outlier add‐on.
*These providers had rate changes during 2011, please see the "Changes since prior publication" tab.
7 of 7
(11)
**(PER DAY**)
pub_ip_jan2011_wcnf_rev_01_10_12_rev_6‐19‐12.xls
Ref 030
SCHEDULE OF WORKER'S COMPENSATION / NO FAULT (WCNF)
INPATIENT EXEMPT UNIT RATES - EFFECTIVE 1/1/2011 - 12/31/2011 (REVISED)
NYSDOH
(1)
(2)
(3)
SPECIALTY HOSPITAL
(4)
(5)
PSYCHIATRIC
(6)
CHEMICAL DEPENDENCY REHAB
(7)
(8)
CRITICAL ACCESS HOSPITAL
6/20/2012
(9)
(10)
MEDICAL REHABILITATION
(11)
(12)
DETOX
SPECIALTY ACUTE, SPECIALTY ACUTE, DETOX ‐ CRITICAL CHEMICAL CHEMICAL LONG‐TERM CARE LONG‐TERM CARE MEDICALLY CRITICAL ACCESS MEDICAL MEDICAL ACCESS PSYCHIATRIC PSYCHIATRIC DEPENDENCY DEPENDENCY AND CHILDREN'S AND CHILDREN'S HOSPITAL REHAB BILLING REHAB ALC PER MANAGED REHAB HOSPITAL BILLING RATE ALC PER DIEM REHAB BILLING HOSPITAL BILLING DIEM
WITHDRAWAL HOSPITAL BILLING RATE
RATE
ALC PER DIEM
ALC PER DIEM
RATE
RATE
BILLING RATE
ALC PER DIEM
OPCERT
1623001
0101005
0101000
3701000
1624000
0701000
0501000
3801000
7002001
5501000
1427000
7001041
7002002
5957000
3535001
7000001
7001002
5123000
7001003
0601000
5902002
7000011
4429000
2238001
5263700
5263000
5401001
0901001
0824000
4401000
3421000
4458700
4720001
7002051
1001000
3301000
2625000
7001009
5001000
1101000
3301008
0226700
HOSPITAL NAME
ADIRONDACK MEDICAL CENTER
ALB MED CTR SO CLINICAL CAMP
ALBANY MEDICAL CTR HOSP**
ALBERT LINDLEY LEE MEM HOSP
ALICE HYDE MEDICAL CENTER
ARNOT OGDEN MEDICAL CTR
AUBURN MEMORIAL HOSPITAL
AURELIA OSBORN FOX MEM HOSP
BELLEVUE HOSPITAL CENTER
BENEDICTINE HOSPITAL
BERTRAND CHAFFEE HOSPITAL
BETH ISRAEL / KINGS HIGHWAY
BETH ISRAEL MEDICAL CENTER
BLYTHEDALE CHILDRENS HOSP
BON SECOURS COMMUNITY HOSP
BRONX‐LEBANON HOSPITAL CTR
BROOKDALE HOSPITAL MED CTR
BROOKHAVEN MEMORIAL HOSP
BROOKLYN HOSPITAL
BROOKS MEMORIAL HOSPITAL
BURKE REHABILITATION CTR
CALVARY HOSPITAL
CANTON‐POTSDAM HOSPITAL
CARTHAGE AREA HOSPITAL INC
CATSKILL REGIONAL / G HERMANN
CATSKILL REGIONAL MED CTR
CAYUGA MEDICAL CENTER
CHAMPLAIN VALLEY PHYS
CHENANGO MEMORIAL HOSP
CLAXTON‐HEPBURN MED CTR
CLIFTON SPRINGS HOSPITAL
CLIFTON‐FINE HOSPITAL
COBLESKILL REGIONAL HOSP
COLER MEMORIAL HOSP
COLUMBIA MEMORIAL HOSPITAL
COMM‐GEN / GREATER SYRACUSE
COMMUNITY MEMORIAL HOSPITAL
CONEY ISLAND HOSPITAL
CORNING HOSPITAL
CORTLAND REGIONAL MED CTR
CROUSE HOSPITAL
CUBA MEMORIAL HOSPITAL
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$1,638.76
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$1,080.21
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$658.26
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$268.30
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$268.30
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$268.30
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$325.12
$0.00
$0.00
$691.24
$0.00
$545.33
$706.51
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$425.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$296.58
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$450.18
$0.00
Page 1 of 5
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$176.40
$0.00
$0.00
$268.29
$0.00
$176.40
$268.29
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$176.40
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$176.40
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$176.40
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$2,486.49
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$2,360.69
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$2,380.70
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$176.40
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$176.40
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$176.40
$0.00
$0.00
$1,034.98
$0.00
$0.00
$0.00
$0.00
$0.00
$1,198.72
$997.56
$0.00
$0.00
$1,473.75
$0.00
$0.00
$0.00
$0.00
$0.00
$1,343.55
$0.00
$1,152.45
$0.00
$0.00
$1,061.37
$0.00
$0.00
$993.59
$0.00
$0.00
$892.19
$0.00
$0.00
$0.00
$0.00
$0.00
$949.12
$0.00
$1,167.86
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$176.40
$0.00
$0.00
$0.00
$0.00
$0.00
$268.29
$176.40
$0.00
$0.00
$268.29
$0.00
$0.00
$0.00
$0.00
$0.00
$268.29
$0.00
$268.29
$0.00
$0.00
$176.40
$0.00
$0.00
$176.40
$0.00
$0.00
$176.40
$0.00
$0.00
$0.00
$0.00
$0.00
$176.40
$0.00
$268.29
$0.00
$0.00
$0.00
$0.00
(13)
(14)
WCNF SURCHARGES
DETOX ‐ WCNF WCNF MEDICALLY PUBLIC ADDITIONAL SUPERVISED GOODS PUBLIC GOODS WITHDRAWAL POOL POOL BILLING RATE SURCHARGE SURCHARGE
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
pub_ip_jan2011_wcnf_rev_01_10_12_rev_6‐19‐12.xls
Ref 030
SCHEDULE OF WORKER'S COMPENSATION / NO FAULT (WCNF)
INPATIENT EXEMPT UNIT RATES - EFFECTIVE 1/1/2011 - 12/31/2011 (REVISED)
NYSDOH
(1)
(2)
(3)
SPECIALTY HOSPITAL
(4)
(5)
PSYCHIATRIC
(6)
CHEMICAL DEPENDENCY REHAB
(7)
(8)
CRITICAL ACCESS HOSPITAL
6/20/2012
(9)
(10)
MEDICAL REHABILITATION
(11)
(12)
DETOX
SPECIALTY ACUTE, SPECIALTY ACUTE, DETOX ‐ CRITICAL CHEMICAL CHEMICAL LONG‐TERM CARE LONG‐TERM CARE MEDICALLY CRITICAL ACCESS MEDICAL MEDICAL ACCESS PSYCHIATRIC PSYCHIATRIC DEPENDENCY DEPENDENCY AND CHILDREN'S AND CHILDREN'S HOSPITAL REHAB BILLING REHAB ALC PER MANAGED REHAB HOSPITAL BILLING RATE ALC PER DIEM REHAB BILLING HOSPITAL BILLING DIEM
WITHDRAWAL HOSPITAL BILLING RATE
RATE
ALC PER DIEM
ALC PER DIEM
RATE
RATE
BILLING RATE
ALC PER DIEM
OPCERT
1229700
4423000
5127000
3101000
1552701
5526700
4601001
7003000
1401005
3429000
3202003
7003001
7003013
2910000
3402000
2901000
5601000
7002050
4329000
5154001
7002009
4322000
2701001
7002012
5901000
5153000
7001046
5022000
7000002
7003003
5149000
0228000
1401014
1401002
1404000
7001016
7001033
5501001
2728001
5922000
7002017
2424000
HOSPITAL NAME
DELAWARE VALLEY HOSPITAL
E J NOBLE HOSP / GOUVERNEUR
EASTERN LONG ISLAND HOSPITAL
EASTERN NIAGARA HOSPITAL
ELIZABETHTOWN COMMUNITY HOSP
ELLENVILLE REGIONAL HOSPITAL
ELLIS HOSPITAL
ELMHURST HOSPITAL CTR
ERIE COUNTY MEDICAL CENTER**
F F THOMPSON HOSPITAL
FAXTON‐ST LUKES HEALTHCARE
FLUSHING HOSPITAL
FOREST HILLS HOSPITAL
FRANKLIN HOSPITAL
GENEVA GENERAL HOSPITAL
GLEN COVE HOSPITAL
GLENS FALLS HOSPITAL
GOLDWATER MEMORIAL HOSP
GOOD SAMARITAN / SUFFERN
GOOD SAMARITAN / WEST ISLIP
HARLEM HOSPITAL CENTER
HELEN HAYES HOSPITAL
HIGHLAND HOSP OF ROCHESTER
HOSPITAL FOR SPECIAL SURGERY
HUDSON VALLEY HOSPITAL CTR
HUNTINGTON HOSPITAL
INTERFAITH MEDICAL CENTER
IRA DAVENPORT MEMORIAL HOSP
JACOBI MEDICAL CENTER
JAMAICA HOSPITAL
JOHN T MATHER MEMORIAL HOSP
JONES MEMORIAL HOSPITAL
KALEIDA HEALTH
KALEIDA HLTH/WOMAN&CHILDRENS
KENMORE MERCY HOSPITAL
KINGS COUNTY HOSPITAL CENTER
KINGSBROOK JEWISH MED CTR
KINGSTON HOSPITAL
LAKESIDE MEMORIAL HOSPITAL
LAWRENCE HOSPITAL
LENOX HILL HOSPITAL
LEWIS COUNTY GENERAL HOSP
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$714.87
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$268.30
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
$1,103.71
$0.00
$662.50
$304.03
$0.00
$0.00
$0.00
$0.00
$278.35
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$571.70
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$546.19
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Page 2 of 5
$176.40
$0.00
$268.29
$176.40
$0.00
$0.00
$0.00
$0.00
$176.40
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$268.29
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$268.29
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$1,103.71
$0.00
$0.00
$0.00
$2,043.95
$1,819.32
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$176.40
$0.00
$0.00
$0.00
$176.40
$176.40
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$1,481.80
$1,079.69
$0.00
$934.64
$0.00
$0.00
$0.00
$1,187.75
$1,123.91
$1,109.16
$0.00
$0.00
$0.00
$1,965.82
$1,333.52
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$1,417.38
$1,364.15
$0.00
$0.00
$892.58
$0.00
$745.00
$2,000.95
$1,098.94
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$268.29
$176.40
$0.00
$176.40
$0.00
$0.00
$0.00
$176.40
$268.29
$176.40
$0.00
$0.00
$0.00
$268.29
$268.29
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$268.29
$268.29
$0.00
$0.00
$176.40
$0.00
$176.40
$268.29
$268.29
$0.00
$0.00
$0.00
$0.00
$0.00
(13)
(14)
WCNF SURCHARGES
DETOX ‐ WCNF WCNF MEDICALLY PUBLIC ADDITIONAL SUPERVISED GOODS PUBLIC GOODS WITHDRAWAL POOL POOL BILLING RATE SURCHARGE SURCHARGE
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
pub_ip_jan2011_wcnf_rev_01_10_12_rev_6‐19‐12.xls
Ref 030
SCHEDULE OF WORKER'S COMPENSATION / NO FAULT (WCNF)
INPATIENT EXEMPT UNIT RATES - EFFECTIVE 1/1/2011 - 12/31/2011 (REVISED)
NYSDOH
(1)
(2)
(3)
SPECIALTY HOSPITAL
(4)
(5)
PSYCHIATRIC
(6)
CHEMICAL DEPENDENCY REHAB
(7)
(8)
CRITICAL ACCESS HOSPITAL
6/20/2012
(9)
(10)
MEDICAL REHABILITATION
(11)
(12)
DETOX
SPECIALTY ACUTE, SPECIALTY ACUTE, DETOX ‐ CRITICAL CHEMICAL CHEMICAL LONG‐TERM CARE LONG‐TERM CARE MEDICALLY CRITICAL ACCESS MEDICAL MEDICAL ACCESS PSYCHIATRIC PSYCHIATRIC DEPENDENCY DEPENDENCY AND CHILDREN'S AND CHILDREN'S HOSPITAL REHAB BILLING REHAB ALC PER MANAGED REHAB HOSPITAL BILLING RATE ALC PER DIEM REHAB BILLING HOSPITAL BILLING DIEM
WITHDRAWAL HOSPITAL BILLING RATE
RATE
ALC PER DIEM
ALC PER DIEM
RATE
RATE
BILLING RATE
ALC PER DIEM
OPCERT
7000008
2129700
2902000
7001017
7003004
7001019
7001020
1226701
3824000
4402000
3622000
7002020
0101003
1401008
2909000
7002021
2701006
7000006
1564701
7003015
7002024
3121001
5903000
2950002
1701000
7002000
3102000
2527000
7000024
2951001
1327000
5920000
7001008
7002026
7003010
7001021
7002054
7002054
7000025
4324000
7002053
7002053
HOSPITAL NAME
LINCOLN MEDICAL
LITTLE FALLS HOSPITAL
LONG BEACH MEDICAL CENTER
LONG ISLAND COLLEGE HOSPITAL
LONG ISLAND JEWISH
LUTHERAN MEDICAL CENTER
MAIMONIDES MEDICAL CENTER
MARGARETVILLE HOSPITAL
MARY IMOGENE BASSETT HOSP
MASSENA MEMORIAL HOSPITAL
MEDINA MEMORIAL HLTH CARE
MEMORIAL HOSP FOR CANCER
MEMORIAL HOSP OF ALBANY
MERCY HOSPITAL OF BUFFALO
MERCY MEDICAL CENTER
METROPOLITAN HOSPITAL CENTER
MONROE COMMUNITY HOSPITAL
MONTEFIORE MEDICAL CENTER
MOSES‐LUDINGTON HOSPITAL
MOUNT SINAI HOSP OF QUEENS
MOUNT SINAI HOSPITAL
MOUNT ST MARYS HOSPITAL
MOUNT VERNON HOSPITAL
NASSAU UNIV MED CTR
NATHAN LITTAUER HOSPITAL
NEW YORK DOWNTOWN HOSP
NIAGARA FALLS MEMORIAL
NICHOLAS H NOYES MEMORIAL
NORTH CENTRAL BRONX HOSPITAL
NORTH SHORE UNIVERSITY HOSP
NORTHERN DUTCHESS HOSPITAL
NORTHERN WESTCHESTER HOSP
NY COMMUNITY / BROOKLYN
NY EYE AND EAR INFIRMARY
NY MED CTR OF QUEENS
NY METHODIST HOSP / BROOKLYN
NY PRESBYTERIAN HOSPITAL
NY PRESBYTERIAN HOSPITAL (PRESBY)
NY WESTCHESTER SQUARE MED CTR
NYACK HOSPITAL
NYU HOSPITALS CENTER
NYU HOSPITALS CENTER/HOSP FOR JOINT DIS
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$3,108.62
$0.00
$0.00
$0.00
$0.00
$2,473.56
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$268.30
$0.00
$0.00
$0.00
$0.00
$176.41
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$347.20
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$695.89
$695.89
$0.00
$440.01
$0.00
$0.00
Page 3 of 5
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$176.40
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$268.29
$268.29
$0.00
$268.29
$0.00
$0.00
$0.00
$1,490.41
$0.00
$0.00
$0.00
$0.00
$0.00
$1,941.11
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$2,587.36
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$176.40
$0.00
$0.00
$0.00
$0.00
$0.00
$176.40
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$176.40
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$678.96
$1,771.71
$0.00
$824.03
$0.00
$0.00
$0.00
$0.00
$773.85
$0.00
$0.00
$980.09
$892.04
$1,155.63
$0.00
$1,899.46
$0.00
$0.00
$1,393.63
$0.00
$0.00
$1,319.42
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$1,255.85
$0.00
$0.00
$0.00
$0.00
$910.13
$1,567.08
$1,567.08
$0.00
$0.00
$1,495.40
$1,495.40
$0.00
$0.00
$268.29
$268.29
$0.00
$268.29
$0.00
$0.00
$0.00
$0.00
$176.40
$0.00
$0.00
$176.40
$268.29
$268.29
$0.00
$268.29
$0.00
$0.00
$268.29
$0.00
$0.00
$268.29
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$176.40
$0.00
$0.00
$0.00
$0.00
$268.29
$268.29
$268.29
$0.00
$0.00
$268.29
$268.29
(13)
(14)
WCNF SURCHARGES
DETOX ‐ WCNF WCNF MEDICALLY PUBLIC ADDITIONAL SUPERVISED GOODS PUBLIC GOODS WITHDRAWAL POOL POOL BILLING RATE SURCHARGE SURCHARGE
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
pub_ip_jan2011_wcnf_rev_01_10_12_rev_6‐19‐12.xls
Ref 030
SCHEDULE OF WORKER'S COMPENSATION / NO FAULT (WCNF)
INPATIENT EXEMPT UNIT RATES - EFFECTIVE 1/1/2011 - 12/31/2011 (REVISED)
NYSDOH
(1)
(2)
(3)
SPECIALTY HOSPITAL
(4)
(5)
PSYCHIATRIC
(6)
(7)
CHEMICAL DEPENDENCY REHAB
(8)
6/20/2012
(9)
CRITICAL ACCESS HOSPITAL
(10)
(11)
MEDICAL REHABILITATION
(12)
DETOX
SPECIALTY ACUTE, SPECIALTY ACUTE, DETOX ‐ CRITICAL CHEMICAL CHEMICAL LONG‐TERM CARE LONG‐TERM CARE MEDICALLY CRITICAL ACCESS MEDICAL MEDICAL ACCESS PSYCHIATRIC PSYCHIATRIC DEPENDENCY DEPENDENCY AND CHILDREN'S AND CHILDREN'S HOSPITAL REHAB BILLING REHAB ALC PER MANAGED REHAB HOSPITAL BILLING RATE ALC PER DIEM REHAB BILLING HOSPITAL BILLING DIEM
WITHDRAWAL HOSPITAL BILLING RATE
RATE
ALC PER DIEM
ALC PER DIEM
RATE
RATE
BILLING RATE
ALC PER DIEM
OPCERT
1254700
0401001
2601001
3523000
3702000
0301001
5155000
7003006
5932000
2952005
3950000
7003007
7004010
2221700
2701003
7002031
3201002
1401010
4102002
2201000
4501000
4823700
4102003
1401006
1401013
6120700
5904000
2950001
5126000
5154000
3529000
7000014
5157003
5149001
3202002
1302000
2953000
5002001
7001024
5907001
HOSPITAL NAME
O'CONNOR HOSPITAL
OLEAN GENERAL HOSPITAL
ONEIDA HEALTHCARE CENTER
ORANGE REGIONAL MED CTR
OSWEGO HOSPITAL
OUR LADY OF LOURDES MEMORIAL
PECONIC BAY MED CTR
PENINSULA HOSPITAL CENTER
PHELPS MEMORIAL HOSP
PLAINVIEW HOSPITAL
PUTNAM COMMUNITY HOSPITAL
QUEENS HOSPITAL CENTER
RICHMOND UNIV MED CTR
RIVER HOSPITAL
ROCHESTER GENERAL HOSPITAL
ROCKEFELLER UNIVERSITY
ROME HOSPITAL AND MURPHY
ROSWELL PARK SAMARITAN HOSPITAL OF TROY
SAMARITAN MEDICAL CENTER
SARATOGA HOSPITAL
SCHUYLER HOSPITAL
SETON HEALTH SYSTEMS
SHEEHAN MEMORIAL EMERGENCY
SISTERS OF CHARITY HOSPITAL
SOLDIERS AND SAILORS MEM HOSP
SOUND SHORE MEDICAL CENTER
SOUTH NASSAU COMMUNITIES
SOUTHAMPTON HOSPITAL
SOUTHSIDE HOSPITAL
ST ANTHONY COMMUNITY HOSP
ST BARNABAS HOSPITAL
ST CATHERINE OF SIENA
ST CHARLES HOSPITAL
ST ELIZABETH MEDICAL CENTER
ST FRANCIS HOSP / POUGH
ST FRANCIS HOSP / ROSLYN
ST JAMES MERCY HOSPITAL
ST JOHNS EPISCOPAL SO SHORE
ST JOHNS RIVERSIDE HOSPITAL
ST JOSEPH HOSPITAL (formerly NEW ISLAND 2952006 HOSP)
(13)
(14)
WCNF SURCHARGES
DETOX ‐ WCNF WCNF MEDICALLY PUBLIC ADDITIONAL SUPERVISED GOODS PUBLIC GOODS WITHDRAWAL POOL POOL BILLING RATE SURCHARGE SURCHARGE
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$2,317.02
$0.00
$2,691.80
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$268.30
$0.00
$176.41
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$582.71
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$199.19
$305.33
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$262.35
$0.00
$331.47
$0.00
$318.01
$0.00
$481.40
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$268.29
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$176.40
$176.40
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$268.29
$0.00
$176.40
$0.00
$176.40
$0.00
$268.29
$2,401.21
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$2,352.36
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$1,412.00
$0.00
$0.00
$0.00
$1,763.08
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$176.40
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$176.40
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$176.40
$0.00
$0.00
$0.00
$176.40
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$1,044.11
$0.00
$0.00
$0.00
$1,376.18
$1,441.81
$0.00
$0.00
$1,584.74
$0.00
$0.00
$1,124.01
$0.00
$1,025.76
$0.00
$0.00
$1,187.08
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$1,271.68
$0.00
$0.00
$0.00
$837.36
$0.00
$1,232.49
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$176.40
$0.00
$0.00
$0.00
$268.29
$268.29
$0.00
$0.00
$268.29
$0.00
$0.00
$176.40
$0.00
$176.40
$0.00
$0.00
$176.40
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$268.29
$0.00
$0.00
$0.00
$268.29
$0.00
$176.40
$0.00
$0.00
$0.00
$0.00
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
$0.00
$0.00
TBD
TBD
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Published Separately
9.63%
28.27%
Page 4 of 5
pub_ip_jan2011_wcnf_rev_01_10_12_rev_6‐19‐12.xls
Ref 030
SCHEDULE OF WORKER'S COMPENSATION / NO FAULT (WCNF)
INPATIENT EXEMPT UNIT RATES - EFFECTIVE 1/1/2011 - 12/31/2011 (REVISED)
NYSDOH
(1)
(2)
SPECIALTY HOSPITAL
(3)
(4)
PSYCHIATRIC
(5)
(6)
CHEMICAL DEPENDENCY REHAB
(7)
(8)
6/20/2012
(9)
CRITICAL ACCESS HOSPITAL
(10)
MEDICAL REHABILITATION
(11)
(12)
DETOX
SPECIALTY ACUTE, SPECIALTY ACUTE, DETOX ‐ CRITICAL CHEMICAL CHEMICAL LONG‐TERM CARE LONG‐TERM CARE MEDICALLY CRITICAL ACCESS MEDICAL MEDICAL ACCESS PSYCHIATRIC PSYCHIATRIC DEPENDENCY DEPENDENCY AND CHILDREN'S AND CHILDREN'S HOSPITAL REHAB BILLING REHAB ALC PER MANAGED REHAB HOSPITAL BILLING RATE ALC PER DIEM REHAB BILLING HOSPITAL BILLING DIEM
WITHDRAWAL HOSPITAL BILLING RATE
RATE
ALC PER DIEM
ALC PER DIEM
RATE
RATE
BILLING RATE
ALC PER DIEM
OPCERT
0701001
3301003
5907002
7002032
3522000
2801001
0101004
7001037
7004003
2701005
4353000
4601004
2754001
0427000
1227001
0303001
1801000
5151001
3301007
1302001
5820000
5957001
0632000
5902001
2908000
0602001
7001045
7001035
6027000
HOSPITAL NAME
ST JOSEPHS HOSP / ELMIRA
ST JOSEPHS HOSP HLTH CTR
ST JOSEPHS HOSPITAL YONKERS
ST LUKES / ROOSEVELT HOSP
ST LUKES CORNWALL
ST MARYS HOSP / AMSTERDAM
ST PETERS HOSPITAL
STATE UNIV HOSP / DOWNSTATE
STATEN ISLAND UNIV HOSP
STRONG MEMORIAL HOSPITAL
SUMMIT PARK HOSPITAL
SUNNYVIEW HOSP AND REHAB
THE UNITY HOSPITAL
TLC HEALTH NETWORK
TRI‐TOWN REGIONAL HEALTHCARE
UNITED HEALTH SERVICES INC
UNITED MEMORIAL MED CTR
UNIV HOSP AT STONY BROOK
UNIV HOSP SUNY HLTH SCI CTR
VASSAR BROTHERS MED CTR
WAYNE HEALTH CARE
WESTCHESTER MEDICAL CENTER
WESTFIELD MEMORIAL HOSP
WHITE PLAINS HOSPITAL
WINTHROP UNIVERSITY HOSPITAL
WOMANS CHRISTIAN ASSOC
WOODHULL MEDICAL
WYCKOFF HEIGHTS HOSPITAL
WYOMING CO COMMUNITY HOSP
$0.00
$0.00
TBD
TBD
$313.05
$176.40
$0.00
$0.00
TBD
TBD
$0.00
$0.00
$0.00
$0.00
TBD
TBD
$422.08
$268.29
$0.00
$0.00
TBD
TBD
$549.45
$268.29
$0.00
$0.00
TBD
TBD
$0.00
$0.00
$0.00
$0.00
TBD
TBD
$389.41
$176.40
$0.00
$0.00
TBD
TBD
$0.00
$0.00
$0.00
$0.00
TBD
TBD
$0.00
$0.00
$0.00
$0.00
TBD
TBD
$553.87
$268.29
$0.00
$0.00
TBD
TBD
$0.00
$0.00
$0.00
$0.00
TBD
TBD
$0.00
$0.00
$0.00
$0.00
TBD
TBD
$0.00
$0.00
$0.00
$0.00
TBD
TBD
$377.64
$176.40
$0.00
$0.00
TBD
TBD
$196.02
$176.40
$0.00
$0.00
TBD
TBD
$0.00
$0.00
$0.00
$0.00
TBD
TBD
$415.46
$176.40
$0.00
$0.00
TBD
TBD
$359.77
$176.40
$0.00
$0.00
TBD
TBD
$0.00
$0.00
$0.00
$0.00
TBD
TBD
$0.00
$0.00
$0.00
$0.00
TBD
TBD
$0.00
$0.00
$0.00
$0.00
TBD
TBD
$0.00
$0.00
$0.00
$0.00
TBD
TBD
$0.00
$0.00
$0.00
$0.00
TBD
TBD
$0.00
$0.00
$0.00
$0.00
TBD
TBD
$0.00
$0.00
$0.00
$0.00
TBD
TBD
$0.00
$0.00
$0.00
$0.00
TBD
TBD
$350.79
$176.40
$0.00
$0.00
TBD
TBD
$0.00
$0.00
$0.00
$0.00
TBD
TBD
$0.00
$0.00
$0.00
$0.00
TBD
TBD
$0.00
$0.00
*These providers had rate changes during 2011, please see the "Changes since prior publication" tab.
Page 5 of 5
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$794.89
$0.00
$0.00
$1,389.08
$0.00
$1,051.98
$1,039.05
$1,813.82
$1,326.38
$1,186.82
$948.50
$959.08
$1,096.36
$0.00
$0.00
$1,059.42
$0.00
$0.00
$1,293.38
$0.00
$0.00
$1,515.97
$0.00
$0.00
$0.00
$890.44
$0.00
$0.00
$0.00
$176.40
$0.00
$0.00
$268.29
$0.00
$176.40
$176.40
$268.29
$268.29
$176.40
$268.29
$176.40
$176.40
$0.00
$0.00
$176.40
$0.00
$0.00
$176.40
$0.00
$0.00
$268.29
$0.00
$0.00
$0.00
$176.40
$0.00
$0.00
$0.00
(13)
(14)
WCNF SURCHARGES
DETOX ‐ WCNF WCNF MEDICALLY PUBLIC ADDITIONAL SUPERVISED GOODS PUBLIC GOODS WITHDRAWAL POOL POOL BILLING RATE SURCHARGE SURCHARGE
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
Published Separately
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
9.63%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
28.27%
pub_ip_jan2011_wcnf_rev_01_10_12_rev_6‐19‐12.xls
Ref 030
Changes since prior publication ‐ WCNF
Effective 1/1/2011 ‐ 12/31/2011 (Revised)
NYSDOH
2011 RATE CHANGES SINCE THE RATE FILES THAT WERE INITIALLY POSTED ON 4/18/2011:
CHANGES/CORRECTIONS EFFECTIVE 1/1/11 (INCLUDED IN "PUB_WCNF_Acute" RATE TAB):
ACUTE:
(1)
DISCHARGE RATE
(3)
ISAF
DISCHARGE CASE INSTITUTION‐
SPECIFIC PAYMENT RATE (EXCLUDING PHL ADJUSTMENT § 2807‐c(33))
FACTOR (ISAF)
OPCERT
HOSPITAL NAME
1401005 ERIE COUNTY MEDICAL CENTER
7003015 MOUNT SINAI HOSP OF QUEENS
No Change
$10,255.92
(4)
HIGH COST CC's
HIGH COST CHARGE CONVERTOR
No Change
1.1206
No Change
No Change
(5)
EU:
(6)
(7)
(8)
(5)
(9)
DME RATE
CAPITAL RATE ‐ PER DISCH
CAPITAL RATE ‐ PER DIEM
CHEMICAL DEPENDENCY REHAB
MEDICAL REHABILITATION
CAPITAL PER DIEM
CHEMICAL DEPENDENCY REHAB BILLING RATE
IME %'s
DIRECT INDIRECT MEDICAL MEDICAL EDUCATION EDUCATION (DME) ADD‐
(IME) %
ON
No Change
32.88%
No Change
$1,295.36
CAPITAL PER DISCHARGE PLUS NON‐
COMPARABLES: AMBULANCE, SCHOOL OF NURSING & TEACHING ELECTION AMENDMENT PHYS ADD‐
ONS (Excludes Transition Add‐ons)
$619.63
No Change
$96.39
No Change
$278.35
No Change
MEDICAL REHAB BILLING RATE
$1,079.69
No Change
CHANGES/CORRECTIONS EFFECTIVE 4/1/11 (NOT INCLUDED IN THE "PUB_WCNF_Acute" RATE TAB):
ACUTE:
(1)
DISCHARGE RATE
(3)
ISAF
DISCHARGE CASE INSTITUTION‐
PAYMENT RATE SPECIFIC (EXCLUDING PHL ADJUSTMENT § 2807‐c(33))
FACTOR (ISAF)
OPCERT
0101000
0101000
4601001
5907002
HOSPITAL NAME
ALBANY MEDICAL CTR SO CLINICAL
ALBANY MEDICAL CTR HOSP
ELLIS HOSPITAL
ST JOSEPHS HOSPITAL YONKERS
$7,146.19
$7,146.19
No Change
No Change
(4)
HIGH COST CC's
HIGH COST CHARGE CONVERTOR
0.8689
0.8689
No Change
No Change
0.392209
0.392209
No Change
No Change
(5)
EU:
(6)
(7)
(8)
(9)
DME RATE
CAPITAL RATE ‐ PER DISCH
CAPITAL RATE ‐ PER DIEM
MEDICAL REHABILITATION
CAPITAL PER DIEM
MEDICAL REHAB BILLING RATE
IME %'s
DIRECT INDIRECT MEDICAL MEDICAL EDUCATION EDUCATION (DME) ADD‐
(IME) %
ON
19.41%
19.41%
No Change
No Change
$614.14
$614.14
$158.59
$584.76
CAPITAL PER DISCHARGE PLUS NON‐
COMPARABLES: AMBULANCE, SCHOOL OF NURSING & TEACHING ELECTION AMENDMENT PHYS ADD‐
ONS (Excludes Transition Add‐ons)
$731.72
$731.72
No Change
No Change
$130.18
$130.18
No Change
No Change
No Change
$1,035.37
No Change
No Change
1) Albany Medical Center South Clinical merged with Albany Medical Ctr effective 11/1/10, however the effective date of their merged rates wasn't until 4/1/11
due to an agreement with the facility. The South Clinical site did not have any exempt units.
1 of 4
pub_ip_jan2011_wcnf_rev_01_10_12_rev_6‐19‐12.xls
Ref 030
Changes since prior publication ‐ WCNF
Effective 1/1/2011 ‐ 12/31/2011 (Revised)
NYSDOH
CHANGES EFFECTIVE 5/29/11 (NOT INCLUDED IN THE "PUB_WCNF_Acute" RATE TAB):
(1)
(3)
(4)
DISCHARGE RATE
ISAF
HIGH COST CC's
DISCHARGE CASE INSTITUTION‐
PAYMENT RATE SPECIFIC (EXCLUDING PHL ADJUSTMENT § 2807‐c(33))
FACTOR (ISAF)
OPCERT
HOSPITAL NAME
7001037 SUNY DOWNSTATE MED CTR AT LICH
$9,433.35
1.0909
(5)
(6)
(7)
(8)
CAPITAL RATE ‐ PER CAPITAL RATE ‐ PER DISCH
DIEM
CAPITAL PER DISCHARGE PLUS NON‐
DIRECT COMPARABLES: INDIRECT HIGH COST MEDICAL AMBULANCE, SCHOOL MEDICAL CAPITAL PER DIEM
CHARGE EDUCATION OF NURSING & EDUCATION CONVERTOR
(DME) ADD‐
TEACHING ELECTION (IME) %
ON
AMENDMENT PHYS ADD‐
ONS (Excludes Transition Add‐ons)
0.743965
25.55%
$1,955.94
$889.10
$159.21
IME %'s
DME RATE
1) Long Island College Hospital was acquired by State Univ Hosp / Downstate effective 5/29/2011 to become SUNY Downstate Med Ctr at LICH (7001037). The amounts for their
Exempt Unit rates did not change as part of the acquisition, only the acute rates changed.
CHANGES EFFECTIVE 10/1/11 (NOT INCLUDED IN THE "PUB_WCNF_Acute" RATE TAB):
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
DISCHARGE RATE
STATEWIDE PRICE
ISAF
HIGH COST CC's
IME %'s
DME RATE
CAPITAL RATE ‐ PER DISCH
CAPITAL RATE ‐ PER DIEM
ALC
CAPITAL PER DIEM
ALC PRICE PER DAY
DISCHARGE CASE PAYMENT RATE (EXCLUDING PHL § 2807‐c(33))
OPCERT
HOSPITAL NAME
4102004 BURDETT CARE CENTER
$5,476.28
STATEWIDE BASE PRICE (EXCLUDING PHL § 2807‐
c(33))
$6,887.54
CAPITAL PER DISCHARGE PLUS NON‐
COMPARABLES: INSTITUTION‐
INDIRECT HIGH COST DIRECT MEDICAL AMBULANCE, SCHOOL SPECIFIC MEDICAL CHARGE EDUCATION (DME) ADD‐
OF NURSING & ADJUSTMENT EDUCATION CONVERTOR
ON
TEACHING ELECTION FACTOR (ISAF)
(IME) %
AMENDMENT PHYS ADD‐ONS (Excludes Transition Add‐ons)
0.7951
0.443743
2 of 4
0.00%
$0.00
$211.64
$89.96
$176.41
pub_ip_jan2011_wcnf_rev_01_10_12_rev_6‐19‐12.xls
Ref 030
NYSDOH
Changes since prior publication ‐ WCNF
Effective 1/1/2011 ‐ 12/31/2011 (Revised)
3 of 4
pub_ip_jan2011_wcnf_rev_01_10_12_rev_6‐19‐12.xls
Ref 030
NYSDOH
Changes since prior publication ‐ WCNF
Effective 1/1/2011 ‐ 12/31/2011 (Revised)
(10)
(11)
WCNF SURCHARGES
ADDITIONAL PUBLIC PUBLIC GOODS POOL GOODS POOL SURCHARGE
SURCHARGE
9.63%
28.27%
4 of 4
pub_ip_jan2011_wcnf_rev_01_10_12_rev_6‐19‐12.xls
Ref 030