It is generally perceived that dealing with WC (Workman’s Comp) patients requires extra paperwork, delayed payments as well as keeping oneself updated with the latest State and Federal regulations. For those who may have some apprehensions about the term “Workers Compensation”, it signifies a specific type of medical cover for any injury that’s incurred on the job. Commercial workers’ comp insurance policies can be purchased by the employers, though a few states may administer these policies and programs on their own. The benefits of these plans can also differ based on location of the individual and where the mishap occurred. Here are 12 steps on how the entire process generally goes:
Employee gets injured while on the job.
He/she files a claim for compensation via his/her employer’s worker’s comp designate.
The application is processed and forwarded by the employer’s Human Resources Department to the concerned firm.
Note: Some companies may administer compensation policies of their workers on their own.
The date of injury is established and employee gets a claim number assigned to him.
An adjuster (specialist who coordinates employee care, authorizes treatment process and reviews the progress of the employee) is also assigned to the employee till the latter regains former health.
After authorization, the employee becomes the patient of a healthcare provider.
The patient provides his claim number, injury date, & other details to file claim with the appropriate payer.
Using this information, the provider works with the adjuster to formulate an appropriate treatment plan for fully restoring the patient’s health.
Workers compensation billing claim is submitted using CMS-1500 claim form
When CMS-1500 form is received with appropriate progress notes, the adjuster reviews the charges to determine if only authorized services related to the injury were processed as per the agreement
After authenticating the charges, the adjuster reprices these as per the carrier’s fee schedule
Claim submission turnaround time is usually of about 45 days
As a practitioner, it is necessary to know these 12 steps apart from the regular details related to workers compensation billing. In some states, there can be separate codes too, which can affect the billing and may even lead to claim denials later on. To avoid such situation, before submitting the codes, you must have the WC fee schedule handy so that you are able to use only the right compensation codes.
To learn about how you can streamline the entire process and improve your Workers compensation billing, you can register for a live audio conference by Trish Bukauskas on Wednesday, October 12, 2016. During the presentation, Trish will help you overcome your fears related to WC and will provide tips on what insurance carriers may require and how associated paperwork can be streamlined. Different regulations for certain states as well as the federal division will also be discussed during the session.