Worker’s Comp, No Fault, and Liability Claims
by: Lori Tubia, CPC
It seems more and more patients now have a third party payer for their medical bills. To tighten up information gathering on these patients to ensure payment for these claims as quickly as possible, getting it right from the beginning is key. Here are tips for three types of claims:
No fault claims: If a patient tells you he or she doesn’t know the NF information, have the patient contact their agent while he or she is at your office. Make sure you get the name, address, and phone number of the carrier as well as the claim number, the date of the accident, and the name of the insured on the policy. Contact the carrier. Verify the claim has been accepted and ask if the no fault benefits have been exhausted. Confirm the billing address and file number.
Worker’s Comp: Make sure you get the name, address, and phone number of the carrier; the name, address, and phone number of the employer; the date of injury, the carrier case number, and, if possible, the worker’s comp board number. If a patient doesn’t have all of the WC information, contact the patient’s employer while he or she is at the practice to gather the information. The human resource manager (or if a small company, the accountant) should be able to help you. It is a good idea to also contact the carrier and verify if the claim has been accepted or controverted.
Liability Claims: When patients present with a claim against a third party such as a store, a restaurant, a neighbor, or a school, litigation is often involved. It is important to find out from the insurance company if they will be paying you. Often these cases can drag on, and you will not receive payment until the lawsuit is settled. You have the option to have the patient sign a lien against their settlement entitling you to be paid out of the settlement before the patient gets the balance. You also have the option to have the patient pay you for treatment during the entire process and seek reimbursement through the settlement.