Wiki WORKERS COMP BILLING

[jviggiani]

Hey Everyone!

Are there any Workers Comp specialists out there who can tell me when it is okay to bill a patient's health insurance when they have an active worker's comp injury we are threating them for other than an unrelated injury? Can we bill their health insurance for the work related injury as secondary at any time? I just received word we were told other specialties are billing health insurance secondary to workers comp insurance. Please help!!

Thanks

 

[SharonCollachi]

You cannot bill anything as SECONDARY to work comp because work comp covers the entire bill - there is zero left to bill anyone else. You must take the write-offs.

The only time you can bill a health insurance for a work comp claim is when the work comp company refuses to pay. They cannot deny TREATMENT, they can only deny FINANCIAL RESPONSIBILITY. It is shocking to me how many work comp adjustors don't know this. They think that if they deny it, the patient cannot have it done. I end up educating them that they cannot deny treatment, and if they deny payment, then the patient is free to seek care thru their health insurance. What they then realize, and don't like, is the health insurance may come back and seek payment from the work comp carrier.

 

[Orthocoderpgu]

Ask the "Other specialties" that are billing private insurance as a secondary payer to workers comp if they know how to spell F-R-A-U-D.