Practice Management Alert

Workers' compensation claims can be such a huge pain that they can leave your practice's billers wondering whether they'll be covered for the pain and suffering they have endured to get those claims paid.
 
Billing for workers' comp is similar to billing other payers in a lot of ways, but there are a few key differences billing offices must keep in mind, says consultant Marvel Hammer, RN, CPC, CHCO, president of MJH Consulting in Denver, CO.
 
First, you have to train front desk staff to "put on their thinking caps" to identify workers' comp patients from the get-go, Hammer says. The patient often won't tell you if you don't come right out and ask, she notes. Hint: Take your cue from the reason for the patient's visit. If it sounds like it could be a work-related injury, go ahead and ask.
 
This bit of sleuthing on the front end can make all the difference when it comes to getting your claim paid quickly. If you do everything properly up front, there shouldn't be a problem, says Jennifer Schmutz, CPC, with the Neurological Association in Salt Lake City, Ut.
 
The most common mistakes offices make with workers' comp claims are gathering incomplete information and not knowing whom to call with questions, according to Hammer. To make sure you don't fall into these traps, here's a list of all the information your front desk staff should collect at intake, Hammer offers:
 

date of injury (this is especially important if the patient has multiple claims opened),
 

type of injury
 

claim number (some payers 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, and
 

attorney's name and telephone number, if applicable.
 
Tip: To save staff time at check-in, consider obtaining this information when the appointment is scheduled. Also, make sure the patient has filed a report of the injury with her employer, Hammer reminds providers.
 
Another thing you must do to ensure you receive payment: obtain authorization from the workers' comp carrier to treat the patient.

 Aside from collecting correct and complete information, you must ensure the coding is accurate to secure payment for these claims. You should use an E code to explain the injury; otherwise, the payer is very likely to request additional documentation, warns Yvonne Hoiland, senior coding consultant with Coding Continuum Inc. in Tuscon, Ariz.
 
Remember though, E codes should never be listed as a primary diagnosis   used as secondary, they simply "complete the picture," Hammer says.
 
Another tip: Tell the physician to dictate a separate note for the workers' comp claim if he treats the patient for an unrelated problem during the same visit, Hoiland suggests. Mixing the two can lead to confusion.
 
The really tricky part about billing for workers' comp is that it doesn't fall under HIPAA, so the codes aren't standardized at all  the rules vary from state to state. Therefore, keep copies of your state's rules handy. And remember: Most states don't allow balance billing for workers' comp claims, Hammer notes.
 
Many times a patient will sustain an injury in one state, but seek treatment in another. In these cases, you should follow the rules for the state in which the injury occurred, Hammer instructs. One bright spot is that federal employees fall under federal rules, which are standardized nationwide.