August 2003

Dealing with workers’ comp claims

Workers’ compensation claims can leave your practice’s billing clerks wondering whether they’ll be covered for the pain and suffering they’ve endured to get those claims paid, observes Marvel Hammer, president of MJH consulting in Denver, Colo.

Billing for workers’ comp is in many ways similar to billing other payers, but Hammer suggests keeping a few key differences in mind:

1. Train your staff to flag it. You have to train front desk staff to “put on their thinking caps” to identify workers’ comp patients when they walk in the door, because patients often won’t identify themselves as having been injured at work.

Instruct your staff to pay close attention to the reason for the patient’s visit. If it sounds as if the injury could be work-related, your CA should ask the patient outright and make sure to record the answer.

2. Ask the right questions. The most common mistakes offices make with workers’ comp claims is gathering incomplete information and not knowing who to call with questions, according to Hammer. To make sure you don’t fall into these traps, your front desk staff should collect this information at intake:

• Date of injury (this is important if the patient has multiple claims opened).

• Type of injury.

• Claim number (some payors use the patient’s social security number, but others don’t).

• Name and telephone number of the insurance adjustor or case manager (this is the person you should contact if you hit a billing snag down the line).

• Patient’s employer at the time of injury.

• Workers’ compensation carrier.

• Alternate private insurance information.

• Attorney’s name and telephone number, if applicable.

To save staff time at check-in, consider obtaining this information when the appointment is scheduled. And make sure the patient has filed a report of the injury with her employer.

3. Double-check your coding. Aside from collecting correct and complete information, you must ensure the coding is accurate to secure payment for these claims.

The tricky part about billing for workers’ comp is that it doesn’t fall under HIPAA, so codes are not standardized, says Hammer. The rules vary from state to state, so keep copies of your state’s rules handy. And remember, most states don’t allow balance billing for workers’ comp claims.

Source: Medial Newswire

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