Frequently Asked Questions about Regulation 83 and the No-Fault Fee Schedule
Q: Where can I obtain a copy of the Workers' Compensation Board (WCB) Medical Fee Schedule?
A: Copies of the WCB Medical Fee Schedule may be purchased from OptumInsight, by writing to: Official New York Workers' Compensation Medical Fee Schedule, PO Box 88050, Chicago, IL 60680-9920; or by telephone at 1-800-464-3649 (option #1); or online at www.optumcoding.com, Keyword New York or https://www.optum360coding.com/reference-products/workers-compensation/. The price for a hard copy of the New York Medical Fee Schedule is $100.
Q: Where can I obtain a copy of the new Medicaid Fee Schedule?
A: You must contact the Computer Sciences Corporation Technical Support Unit 800 North Pearl Street Albany, NY 12204. There is a $20.00 charge for non-Medicaid providers. (800) 522-5518, or (800) 522-5535.
Q: What is a CPT code?
A: A CPT code is a method used in describing the type of procedure rendered to patients. CPT stands for Current Procedural Terminology. CPT is a registered trademark of the American Medical Association.
Q: What CPT code is to be used when billing for testing of the novel coronavirus (“Covid-19”) under No-Fault?
A: Refer to the Workers’ Compensation Board’s adoptions and rulemaking on Covid-19 Testing for the appropriate CPT code and rules to be utilized. However, in accordance with section 68.1(b)(1) of Regulation 83, references to workplace exposure and other workers’ compensation procedural requirements in the fee schedule are not applicable to no-fault. For no-fault purposes, Covid-19 testing must be reasonable and necessary and performed by a provider eligible for reimbursement under no-fault and within the provider’s lawful scope of licensure. Information regarding the permanent adoption was published in the April 7, 2021 edition of the State Register.
Q: What is the correct method of billing for an in-patient hospital stay?
A: DFS has adopted the State of New York Department of Health (DOH), Office of Health Systems Management, DRG system for No-Fault related in-patient hospital billing as required by Regulation No. 83, Section 68.2. Under Section 2807-c of the Public Health law (applicable to No-Fault), reimbursements for inpatient hospital billings are made on an individually calculated case based payment per patient discharge ("DRG"). A DRG rate cannot be accurately calculated before a patients discharge, as one of the variables necessary for the calculation is the discharge diagnosis. Any initial payments made based upon an admission of the patient will be reconciled upon discharge. In addition, a hospital is not prohibited from resubmitting an amended/corrected in-patient hospital bill to an insurer if the incorrect DRG rate was inadvertently calculated. If you have any questions regarding the DRG system, you can contact the State of New York Department of Health or review section 2807-c of the Public Health law.
Q: What is the correct billing procedure to be followed by a licensed massage therapist (LMT) when billing for services rendered to No-Fault patient?
A: The Department of Financial Services has not established a fee schedule applicable to a massage therapist. However, the amount a massage therapist can charge is controlled by Regulation No. 83, Section 68.5 (b), which allows massage therapists to bill at the prevailing rate in the geographical area of the provider. Note that an insurer can review a bill and possibly reduce it if the insurer believes that the bill is not consistent with charges for similar procedures in an established fee schedule adopted by the Superintendent of Insurance. Any reduction by an insurer to the charges billed by a health care provider must be denied and can be resolved through arbitration or litigation.
Q: Is there any restriction on any health care provider from prescribing drugs to No-Fault patients under Regulation No. 83?
A:There is no rule restricting a health care provider from prescribing drugs to No-Fault patients unless the health care provider's license prohibits it.
Q: What is the fee schedule for acupuncturists, physical therapists, occupational therapists, self-employed nurse practitioners, physician assistants, licensed social workers, and chiropractors?
A: See below FAQs on the 34th and 35th amendments to Regulation 83 on the effective dates of the delayed adoption of the Workers’ Compensation Board’s fee schedules for no-fault. Note that fees for services prior to October 1, 2020 (except for the noted ground rules effective April 1, 2019) would be governed under the provisions of 11 NYCRR 68.5 for health services not set forth in schedules.
Q: What is the correct fee schedule amount to be charged for ambulance transportation under the New York State No-Fault fee schedule?
A: Regulation No. 83, Part G contains the No-Fault fee schedule for ambulance transportation. Pursuant to this schedule, the maximum permissible charge for ambulance service is the local prevailing charge for such service in the geographic area where rendered.
Q: What are the fee schedule requirements for reimbursement of biofeedback services?
A: The fee schedule requirements for reimbursement of biofeedback are contained within Rule 1 of the Workers' Compensation Board Medical Fee Schedule, and the fee schedule requirements for biofeedback rendered as a psychological treatment are contained within Rule 1 of the Psychology Fee Schedule (note that WCB pre-authorization requirements are not applicable to No-Fault). These ground rules would control, and biofeedback would be reimbursable only if it is performed by either a licensed physician or a psychologist.
Q: Would a medical PC be eligible for reimbursement for biofeedback services rendered by a technician, working under direct and personal supervision of a Board certified internist, both of whom possess a training certificate in biofeedback?
A: No. Only those services actually performed by the licensed professional (i.e.: an internist) which are within the lawful scope of the licensee's practice are eligible for reimbursement by No-Fault. If the licensee through professional education and training were qualified to perform biofeedback, then the licensee (or their PC) would be eligible for reimbursement for biofeedback. Although it is permissible for a technician certified in biofeedback to work under the direct and personal supervision of a Board Certified internist who is also certified in biofeedback, inasmuch as the technician is not professionally licensed the services performed by the technician are not eligible for reimbursement under No-Fault.
Q: What is the correct fee schedule amount to be charged for a medical service or procedure that does not have a specific unit value listed in the Workers' Compensation Board Medical Fee Schedule?
A: Although most medical services and procedures are included within the Workers' Compensation Board Medical Fee Schedule, certain services are relatively unique in nature and do not have a specific unit value indicated within the fee schedule. These procedures are referred to as BR, or "by report" items. Fees for such services must be justified by the submission of a written report. The provider shall establish a unit value consistent in relativity with other unit values shown in the fee schedule.
If the health provider and the No-Fault insurer cannot agree on the correct level of reimbursement for services rendered, that would constitute a question of fact which should be submitted to No-Fault arbitration or a court of competent jurisdiction for resolution.
Q: My doctor accepted a No-Fault assignment and rendered treatment. My insurer recently issued a denial of claim based on the results of an insurer medical examination. Can the doctor bill me directly?
A: No. By accepting an assignment, the health care provider (assignee) entered into a contract with the injured party (assignor). If the insurer denied payment for medical services rendered based on the results of an insurer medical examination (IME), the assignee must pursue a remedy in court or arbitration. A health care provider who accepted an assignment of benefits from a No-Fault patient cannot bill the patient directly if the submitted claim was denied based on an insurer medical examination.
However, an assignment may be revoked by an assignee when benefits are not payable based upon the assignor's lack of coverage and/or violation of a policy condition due to the actions of conduct of the assignor.
Q: What happens if my claim is denied?
A: If the claim is denied the assignee may file a consumer complaint with this Department by including a copy of the assignment of benefits form. Additionally, the assignee may proceed with no fault arbitration. The instructions for filing no fault arbitration are included on the back of the No Fault Denial of Claim Form (NF-10).
Q: The insurance company reduced the amount of a medical bill to the Workers' Compensation fee schedule charges. Am I responsible to pay my doctor the difference between "fee schedule" and the amount he/she previously billed?
A: No. A health care provider is required by Section 5108 of the Insurance Law to bill in accordance with the No-Fault fee schedules. A provider can not balance bill a patient for fees in excess of those contained in the fee schedule.
Q: A health provider continuously submits bills that are not at Workers' Compensation fee schedule charges. Payment is issued by the insurer for the correct fee schedule amount and excess charges are denied. Although the health provider has not disputed any prior fee schedule reductions, the provider continues to bill in excess of the fee schedule. What can an insurer do to correct this provider's behavior?
A: If a health care provider has established a pattern of billing more than what is allowable by the No-Fault fee schedules in violation of the requirements of Section 5108 of the Insurance Law, insurers should report such overcharging to the Department as required by Section 68.8 of Regulation 83. The Department of Financial Services will report to the appropriate authorities those health care providers who continue to bill in excess of the fee schedule.
Q: If the insurer denies payment for continued health care based on a question of medical necessity and the patient decides to file for arbitration, is the health provider required to continue to bill in accordance with the No-Fault fee schedule?
A: Yes, the provider must continue to bill at No-Fault fee schedule rates in this instance. If continued treatment is denied based upon the results of an insurer medical examination or a peer review, this constitutes a question of medical fact which must be resolved through No-Fault arbitration or a court of competent jurisdiction.
Q: What is the effective date of the 28th Amendment to Regulation 83, and does it affect existing claims or only new claims?
A: October 6, 2004. The changes effected by the 28th Amendment to Regulation 83 would be applicable to claims with a dates of service occurring on or after October 6, 2004. If a claim contains dates of service which are both prior to and after October 6, 2004, the portion of the claim incurred prior to that date would not be subject to the 28th Amendment to Regulation 83.
Q: How can I confirm if a health provider is licensed in New York?
A: You may contact the New York State Education Department (NYSED), Office of Professions, to inquire whether a provider is licensed. You can also go to the NYSED website at http://usny.nysed.gov/professionals/ for online license verification.
The 29th Amendment to Regulation 83
Q: What was the purpose of the 29th Amendment to Regulation 83?
A: The changes implemented by the 29th Amendment to Regulation 83 were required in order to update the mailing address (of the NYS Department of Health and the NYS Department of Education) to be used by insurers when reporting any pattern of overcharging, excessive treatment or other improper actions committed by physicians or physician's assistants, hospitals, or other health providers.
The 33rd Amendment to Regulation 83
Q:What was the purpose of the 33rd Amendment to Regulation 83?
A: The changes implemented by the 33rd Amendment to Regulation 83 were necessary to address inconsistency in determining the prevailing fees for treatment received outside of New York State resulting in costly arbitration and litigation in settling disputes, as well as the rapid depletion of available no-fault benefits from excessive and exaggerated billing from out-of-state providers.
Q: What is the effective date of the 33rd Amendment to Regulation 83, and does it affect existing claims or only new claims?
A: January 23, 2018. The changes effected by the 33rd Amendment to Regulation 83 would be applicable to claims with a date of service occurring on or after January 23, 2018. If a claim contains dates of service which are both prior to and after January 23, 2018, the portion of the claim incurred prior to that date would not be subject to the 33rd Amendment to Regulation 83, irrespective of the date of accident, or the date the bill was received by the insurer.
Q: When a patient is covered by New York State No-Fault and is treated outside of the State of New York, how is this billed?
A: Prior to the 33rd amendment to Regulation 83, the maximum permissible charge for treatment received outside of New York State was at the prevailing fee in the geographic location of the health provider. The amendment limits reimbursement to the lowest of (1) the amount of the fee in the region in New York State that has the highest applicable amount in the fee schedule for that service; (2) the amount charged by the provider; and (3) the prevailing fee in the geographic location of the provider. This limitation on reimbursement does not apply to (1) services provided out-of-state that would constitute emergency care, (2) that is provided to a non-resident of New York State, or (3) provided to a New York State resident who, at the time of treatment, is residing in the jurisdiction where the treatment is being rendered for reasons unrelated to the treatment. Under these three exceptions, reimbursement is at the lower of the amount charged by the provider and the prevailing fee in the geographic location of the provider. If the jurisdiction where the out-of-state provider renders treatment has established a fee schedule for services rendered in connection with motor vehicle-related injuries, the prevailing fee shall be the amount prescribed in that fee schedule for the respective service. Note that the provisions of the 33rd amendment to Regulation 83 remain in effect and is not superseded by General Ground Rule 16, Treatment by Out-of-State Providers in the Workers’ Compensation Medical Fee Schedule.
The 34th Amendment to Regulation 83
Q: What was the purpose of the 34th Amendment to Regulation 83?
A: The changes implemented by the 34th Amendment to Regulation 83 for the purpose of the no-fault system is to delay for 18 months, with exceptions, the adoption of the new Workers’ Compensation Board’s Fee Schedules promulgated on December 11, 2018 with an effective date of April 1, 2019. The amendment also provides that any references in any workers’ compensation ground rules regarding time limitations within which health services must be performed, as well as any enhanced reimbursement for providers of certain designated services (Medical Fee Schedule General Ground Rule 17), are inapplicable to no-fault.
Q: What is the effective date of the 34th Amendment to Regulation 83, and does it affect existing claims or only new claims?
A: April 1, 2019.
1)With the exception of certain ground rules, the amendment will delay the implementation of the new fee schedules for 18-months until October 1, 2020, and the new fee schedules shall only apply to charges for health services performed on or after October 1, 2020. If a claim contains dates of service which are both prior to and after October 1, 2020, the portion of the claim incurred prior to that date would not be subject to the amendment (i.e. the new fee schedules), irrespective of the date of accident, or the date the bill was received by the insurer.
2)The four excepted ground rules that will take effect on April 1, 2019 are as follows: General Ground Rule 10 in the Workers’ Compensation Chiropractic Fee Schedule, General Ground Rule 13 in the Workers’ Compensation Behavioral Health Fee Schedule, and General Ground Rule 16 in the Workers’ Compensation Podiatry Fee Schedule, which prohibit providers to whom these fee schedules apply from billing under current procedural terminology (“CPT”) codes not listed in their respective fee schedules; and General Ground Rule 19 in the Workers’ Compensation Medical Fee Schedule, which prohibits any chiropractor, podiatrist or provider of behavioral health services from billing under CPT codes in the medical fee schedule.
These ground rules shall apply to all charges for health services performed on or after April 1, 2019. If a claim contains dates of service which are both prior to and after April 1, 2019, the portion of the claim incurred prior to that date would not be subject to the amendment, irrespective of the date of accident, or the date the bill was received by the insurer.
The 35th Amendment to Regulation 83
Q: What was the purpose of the 35th Amendment to Regulation 83?
A:The changes implemented by the 35th Amendment to Regulation 83 for the purpose of the no-fault system is to delay for 9 months, adoption of the amendments to the Workers’ Compensation Board’s Fee Schedules promulgated on November 19, 2019 with an effective date of January 1, 2020. The amendments impact billing by acupuncturists, physical therapists, occupational therapists, self-employed nurse practitioners, physician assistants, licensed social workers, and chiropractors.
Q: What is the effective date of the 35th Amendment to Regulation 83, and does it affect existing claims or only new claims?
A: October 1, 2020. The changes effected by the 35th Amendment to Regulation 83 would be applicable to claims with a date of service occurring on or after October 1, 2020. If a claim contains dates of service which are both prior to and after October 1, 2020, the portion of the claim incurred prior to that date would not be subject to the 35th Amendment to Regulation 83, irrespective of the date of accident, or the date the bill was received by the insurer.
Telemedicine due to Covid-19
Q: Is telemedicine applicable to No-Fault?
A: Yes, the Chair of the Workers’ Compensation Board adopted emergency regulations to allow telemedicine in some circumstances for social distancing purposes due to outbreak of COVID-19.
Q: What is the effective date of telemedicine for no-fault purposes, and does it affect existing claims or only new claims?
A: The Workers’ Compensation Board promulgated fourteen emergency regulations regarding telemedicine. The first emergency rulemaking took effect on March 16, 2020. This emergency rulemaking shall apply to all no-fault claims with a date of service occurring on or after March 16, 2020 through April 19, 2020. The Notice of Emergency Adoption was published in the April 1, 2020 edition of the State Register. Information regarding this emergency rulemaking may be found on the State Register’s website at the following link: https://dos.ny.gov/system/files/documents/2020/10/040120.pdf
The Workers’ Compensation Board’s second emergency rulemaking regarding telemedicine took effect on April 20, 2020. This emergency rulemaking shall apply to all no-fault claims with a date of service occurring on or after April 20, 2020. The Notice of Emergency Adoption was published in the May 6, 2020 edition of the State Register and was effective for 90 days from the April 20, 2020 filing. Information regarding this emergency rulemaking may be found on the State Register’s website at the following link: https://dos.ny.gov/system/files/documents/2020/10/050620.pdf
The Workers’ Compensation Board’s third emergency rulemaking regarding telemedicine took effect on July 20, 2020. This emergency rulemaking shall apply to all no-fault claims with a date of service occurring on or after July 20, 2020. The Notice of Emergency Adoption was published in the August 5, 2020 edition of the State Register and was effective for 90 days from the July 20, 2020 filing. Information regarding this emergency rulemaking may be found on the State Register’s website at the following link: https://dos.ny.gov/system/files/documents/2020/10/080520.pdf
The Workers’ Compensation Board’s fourth emergency rulemaking regarding telemedicine took effect on October 19, 2020. This emergency rulemaking shall apply to all no-fault claims with a date of service occurring on or after October 19, 2020. The Notice of Emergency Adoption was published in the November 4, 2020 edition of the State Register and is effective for 90 days from the October 19, 2020 filing. Information regarding this emergency rulemaking may be found on the State Register’s website at the following link: https://dos.ny.gov/system/files/documents/2021/04/110420.pdf
The Workers’ Compensation Board’s fifth emergency rulemaking regarding telemedicine took effect on January 18, 2021. This emergency rulemaking shall apply to all no-fault claims with a date of service occurring on or after January 18, 2021. The Notice of Emergency Adoption was published in the January 27, 2021 edition of the State Register and is effective for 90 days from the January 12, 2021 filing. Information regarding this emergency rulemaking may be found on the State Register’s website at the following link: https://dos.ny.gov/system/files/documents/2021/04/012721.pdf
The Workers’ Compensation Board’s sixth emergency rulemaking regarding telemedicine took effect on April 13, 2021. This emergency rulemaking shall apply to all no-fault claims with a date of service occurring on or after April 13, 2021. The Notice of Emergency Adoption was published in the April 28, 2021 edition of the State Register and is effective for 90 days from the April 13, 2021 filing. Information regarding this emergency rulemaking may be found on the State Register’s website at the following link: https://dos.ny.gov/system/files/documents/2021/04/042821.pdf
The Workers’ Compensation Board’s seventh emergency rulemaking regarding telemedicine took effect on July 13, 2021. This emergency rulemaking shall apply to all no-fault claims with a date of service occurring on or after July 13, 2021. The Notice of Emergency Adoption was published in the July 28, 2021 edition of the State Register and is effective for 90 days from the July 13, 2021 filing. Information regarding this emergency rulemaking may be found on the State Register’s website at the following link: https://dos.ny.gov/system/files/documents/2021/07/072821.pdf
The Workers’ Compensation Board’s eighth emergency rulemaking regarding telemedicine took effect on October 12, 2021. This emergency rulemaking shall apply to all no-fault claims with a date of service occurring on or after October 12, 2021. The Notice of Emergency Adoption was published in the October 27, 2021 edition of the State Register and is effective for 90 days from the October 12, 2021 filing. Information regarding this emergency rulemaking may be found on the State Register’s website at the following link: https://dos.ny.gov/system/files/documents/2021/10/102721.pdf
The Workers’ Compensation Board’s ninth emergency rulemaking regarding telemedicine took effect on January 11, 2022. This emergency rulemaking shall apply to all no-fault claims with a date of service occurring on or after January 11, 2022. The Notice of Emergency Adoption was published in the January 26, 2022 edition of the State Register and is effective for 90 days from the January 11, 2022 filing. Information regarding this emergency rulemaking may be found on the State Register’s website at the following link: https://dos.ny.gov/system/files/documents/2022/01/012622_0_0.pdf
The Workers’ Compensation Board’s tenth emergency rulemaking regarding telemedicine took effect on April 12, 2022. This emergency rulemaking shall apply to all no-fault claims with a date of service occurring on or after April 12, 2022. The Notice of Emergency Adoption was published in the April 27, 2022 edition of the State Register and is effective for 90 days from the April 12, 2022 filing. Information regarding this emergency rulemaking may be found on the State Register’s website at the following link: https://dos.ny.gov/system/files/documents/2022/04/042722.pdf
The Workers’ Compensation Board’s eleventh emergency rulemaking regarding telemedicine took effect on July 12, 2022. This emergency rulemaking shall apply to all no-fault claims with a date of service occurring on or after July 12, 2022. The Notice of Emergency Adoption was published in the July 27, 2022 edition of the State Register and is effective for 90 days from the July 12, 2022 filing. Information regarding this emergency rulemaking may be found on the State Register’s website at the following link: https://dos.ny.gov/system/files/documents/2022/07/072722.pdf
The Workers’ Compensation Board’s twelfth emergency rulemaking regarding telemedicine took effect on October 11, 2022. This emergency rulemaking shall apply to all no-fault claims with a date of service occurring on or after October 11, 2022. The Notice of Emergency Adoption was published in the October 26, 2022 edition of the State Register and is effective for 90 days from the October 11, 2022 filing. Information regarding this emergency rulemaking may be found on the State Register’s website at the following link: https://dos.ny.gov/system/files/documents/2022/10/fe1cb28b-633a-4add-8418-052b3bb40d9b.102622.pdf
The Workers’ Compensation Board’s thirteenth emergency rulemaking regarding telemedicine took effect on January 10, 2023. This emergency rulemaking shall apply to all no-fault claims with a date of service occurring on or after January 10, 2023. The Notice of Emergency Adoption was published in the January 25, 2023 edition of the State Register and is effective for 90 days from the January 10, 2023 filing. Information regarding this emergency rulemaking may be found on the State Register’s website at the following link: https://dos.ny.gov/system/files/documents/2023/01/012523.pdf
The Workers’ Compensation Board’s fourteenth emergency rulemaking regarding telemedicine took effect on April 11, 2023. This emergency rulemaking shall apply to all no-fault claims with a date of service occurring on or after April 11, 2023. The Notice of Emergency Adoption was published in the April 26, 2023 edition of the State Register and is effective for 90 days from the April 11, 2023 filing. Information regarding this emergency rulemaking may be found on the State Register’s website at the following link: https://dos.ny.gov/system/files/documents/2023/04/042623.pdf
Health Care Provider FAQs
Q: When using the Workers' Compensation Board (WCB) Medical Fee Schedule to bill, are health providers bound by the preauthorization requirements contained in the fee schedule?
A: No. Regulation No. 83, Section 68.1(b)(1) states that the general instructions and ground rules in the WCB Medical Fee Schedule apply to No-Fault claims, however those ground rules which refer to workers' compensation claim forms, pre-authorization approval and dispute resolution guidelines do not apply to No-Fault.
Q: I accepted a No-Fault assignment from a patient and rendered treatment. When I submitted the bill to the No-Fault insurer, they issued a denial of claim based on the results of an insurer medical examination (IME). Can I pursue the patient directly for payment of this bill?
A: No. A physician who has accepted a No-Fault assignment of benefits from a No-Fault patient may not pursue the patient directly for payment if the No-Fault carrier denies payment for services based upon a determination that the services were not medically necessary. Such action by the provider would not be permitted under the No-Fault assignment of benefits language contained in claim forms required by N.Y. Comp. Codes R. & Regs. tit. 11, 65-3.11(b)(ii) & (iv) (2002) (Regulation 68-C).
The No-Fault assignment is considered a legal contract, wherein the health provider assignee assumes all of the legal rights and privileges of the injured party assignor. The assignee cannot arbitrarily disregard the provisions of a previously accepted No-Fault assignment. Inasmuch as a No-Fault assignment of benefits has been accepted and the No-Fault insurer denied continued treatments as not necessary or related to an automobile accident, the health provider is legally bound to resolve this question of fact through No-Fault arbitration or through a court of competent jurisdiction if they are in disagreement with the insurer's denial of claim. A failure to exercise these remedies constitutes an acceptance of the insurer's determination that health services rendered were not necessary, and under the terms of the assignment the health provider may not bill the patient for services rendered.
Q: If a hospital submits a bill to No-Fault for amount less than the maximum permissible DRG rate, would the No-Fault insurer base it's claim payment on the amount billed by the hospital or the actual DRG rate?
A: As required by Article 28 of the Public Health Law, The New York State Department of Financial Services has adopted the State of New York Department of Health, Office of Health Systems Management, Diagnostic Related Group (DRG) system for No-Fault related in-patient hospital billing through Regulation No. 83, Section 68.2. Article 28, Section 2807 of the Public Health Law states:
“(b-1) (i) For patients discharged on and after January first, nineteen hundred ninety-seven and prior to January first, two thousand and on and after January first, two thousand, payments to general hospitals for reimbursement of inpatient hospital services provided to patients eligible for payments pursuant to the workers' compensation law, the volunteer firefighters' benefit law, the volunteer ambulance workers' benefit law, and the comprehensive motor vehicle insurance reparations act shall be at the rates of payment determined pursuant to this section for state governmental agencies, excluding adjustments pursuant to subdivision fourteen-f of this section."
Based on the foregoing, all charges for hospital inpatient services must be billed and reimbursed in accordance with the DRG rates established by the New York State Health Department. If the hospital billed at a rate less than the maximum permissible DRG rate, the No-Fault insurer must still base it's claim payment on the actual DRG rate.