WC/ non-WC, TPL/ non-TPL

stresscodes

Contributor
Messages
14
Location
Appleton
Best answers
0
HELP! Is there anywhere I can find supporting documentation from a credible source that states is a patient is seen for two separate conditions on the same date (example work-related injury and non-work related condition or auto accident related condition and non-auto condition) the documentation should be separate and billing is done separately? I need to speak about this topic at our Board of Directors meeting and my providers are going to want to see it in black and white. I have read other threads and it seems like this is pretty much industry standard, but I can't find a reliable source to back it up.

Thanks!
Jenny Stress, CPC
Coding Specialist
Hand to Shoulder Center of Wisconsin
 

PLAIDMAN

True Blue
Messages
520
Best answers
0
HELP! Is there anywhere I can find supporting documentation from a credible source that states is a patient is seen for two separate conditions on the same date (example work-related injury and non-work related condition or auto accident related condition and non-auto condition) the documentation should be separate and billing is done separately? I need to speak about this topic at our Board of Directors meeting and my providers are going to want to see it in black and white. I have read other threads and it seems like this is pretty much industry standard, but I can't find a reliable source to back it up.

Thanks!
Jenny Stress, CPC
Coding Specialist
Hand to Shoulder Center of Wisconsin

I am no expert on this topic....but...I have been told in seminars that it causes HIPAA issues....if patient is being seen for WC injury to right shoulder and also being seen for toenail fungus (comm ins) and all documentation is included in one note...then when you send med recs to WC (all my wc payors request every note ) you releasing PHI (fungus) to WC who has no right to that information..... patient has right to privacy on toenail fungus.

maybe at least you could look in that direction...?..
 

stresscodes

Contributor
Messages
14
Location
Appleton
Best answers
0
Thanks PLAIDMAN. This is my understanding to, but I need it in black and white from a reliable source. Providers like evidence to back up what they are told so that's what I was hoping to find. I'll be doing more digging on this in the next couple days.

Thanks,
Jenny
 
Messages
811
Best answers
0
The textbook answer is to maintain a separate area in a patient's chart where the WC or TPL documentation is kept; the purpose, besides billing, is to ensure a patient's health insurance doesn't get records pertaining to the WC/TPL condition and vice versa. Our billing system allows us to do this, but we had to ask the company to build that option in.

"It is important to keep the work related and non-work related
documentation separate. If paper charts are utilized have a separate
chart for the work related injury. Make the chart a different
color to make it easy to identify. If EHR/EMR is used open a
separate progress note and identify it in a way that it will easily be
identified as a work related injury."

This is from a very reliable source, but I can't give you the full document because it's copyright protected and is not to be distributed outside of the class I got the quote from. :(

If you want to approach it from the HIPAA route, as previously mentioned, one major key point of the Privacy Rule is that "insurers providing only workers’ compensation, automobile insurance, and property and casualty insurance are not considered to be health plans." Therefore they are NOT covered entities. If you distribute PHI that's not related to the injury to these carriers, you're violating HIPAA.

"The Privacy Rule does not apply to workers’ compensation insurers, workers’ compensation administrative agencies, or employers. Covered entities may disclose PHI when required by workers’ compensation laws or to obtain payment. The Minimum Necessary provision must be taken into consideration when determining what to disclose." In other words, if you send documentation that's not related to the injury, you've breached the minimum necessary rule. If you have documentation where a provider includes both WC/TPL information AND non-liability information in one note, and you send that note to the WC/TPL carrier, you've breached the privacy rule/minimum necessary.

This would be a good place to start: http://www.hhs.gov/hipaa/for-profes...e/disclosures-workers-compensation/index.html

Can't get more black and white than that. ;)
 
Top