Eli's Rehab Report

Published on Mon Apr 19, 2010 PDF

Don't treat worker's comp like regular health insurance.

Calling the employer of a worker's comp patient involves more than getting a job description if you want to get paid.

This is your window of time to gather the billing information you need to set your reimbursement in motion.

"The employer should tell you how to bill and who their insurer is," says Bubba Klostermann, OT, CVE/R, CEAS, a worker's comp expert with West Texas Rehab in Abilene, Texas.

But you should have a grasp on how the system works in case you have to track down lost dollars. Follow these tips to save time and money:

Don't file the claim with just any payer. "In most states, the law does not allow you to bill a private carrier or the patient unless you get a ruling from your worker's comp commission that you're dealing with a non work-related injury."

Be aware of preauthorization requirements. "In Texas, for example, everything has to be preauthorized to be reimbursed unless the treatment is two weeks within the date of the injury or surgery," Klostermann says. But even then, you should get the claim authorized, he suggests.

Know the claim could take one of several routes. The employer could have worker's compensation insurance or a private accident policy, but in some states employers can be "non-subscribers," Klostermann points out. And if that's the case, the provider must deal directly with the employer or their 3rd party administrator.

Keep track of your contacts and conversations. In worker's comp cases, you should be documenting much more than just the injury info and your rehab documentation. "Note any communication with the [worker's comp] system -- who you spoke to, what time, and what the conversation regarded," emphasizes Jim Dagostino, DPT, PT, PTPN board member and owner of Dagostino Physical Therapy, a PTPN member office in Oceanside, Calif. "In California worker's compensation [contacts] change, and the person who gave you authority may be gone. But when you have to follow-up you have more credibility."