Optometry Coding & Billing Alert

Published on Sun Jul 02, 2006 PDF

Question: I am unsure about a workers- compensation claim. The patient, a traveling business salesman, has insurance in New Jersey, but the problem occurred while he was on a work trip in Oregon. Whose billing rules should I follow for this claim: New Jersey-s, Oregon's or the federal government-s?

New Jersey Subscriber

Answer: You-ll need to follow state rules when filing almost all workers- compensation claims. Each state has a unique set of rules, fee schedule, and setup for what providers the patient can see.

As for which state's rules you should follow, focus on where the claim was first filed. If the patient filed in Oregon, follow the rules and fee schedule for Oregon; if he filed in New Jersey, follow the rules and fee schedule for New Jersey.
 
Note: All workers- comp claims are governed by state laws with two exceptions:

 - National rules govern workers- comp for federal employees.
 - Workers- comp for railroad workers is varied. Some states abide by national rules, but some states have their own rules and fee schedules for railroad workers.
 
-- Advice for Reader Questions and You Be the Expert contributed by David Gibson, OD, FAAO, practicing optometrist in Lubbock, Texas; and Charles Wimbish, OD, president of Wimbish Consulting Group in Martinsville, Va.