Question Workers Comp

jbland

Contributor
Messages
17
Location
Brooklet, GA
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I have a question regarding workers comp. I am in Georgia and this is a Georgia claim. We are seeing a new patient today. The adjuster has sent a list of questions he/she would like the provider to answer? They are questions require more detail than an office visit. I am not sure why they are doing this. The provider just asked me if we can charge for these questions. Can someone please help and give me some insight on this? Thank you in advance.
 

daedolos

Expert
Messages
459
Location
Long Beach
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Normally, as a new patient case, you'd need to file a WC-1 for the 1st Report to Workers Comp State Board. Under the field of "How Injury Occurred", normally you'd write "Please see attached report" then those questions the adjuster sent would be on that document as well as any responses. A more extensive report supports a more extensive E/M.


Peace
@_*
 

TThivierge

Guru
Messages
173
Location
Lithonia, GA
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Hello! Each state does work comp claims a bit differently but I know you need date of original injury, claim # from their insurance company(the patient should have documents eventually of proof from job), patient SS# number and employer tax ID and special Worker Company assigned number for employer. Also whatever is assigned the original dx injury code; it will need to be on all future claims. I do know if the patient CAUSED the injury; WC may not pay. Also check out if the patient has private insurance and hopefully the private insurance did not pay. If the primary payer did pay in error ; the work comp payer needs to know this fact. The physician should answer the questions from the WC paperwork. Hopefully the doc is approved/credentialed for doing GA Work Comp.
Good Luck!
Lady T:cool:
 

cvanemon

New
Local Chapter Officer
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6
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In workers' comp it is typical to have an adjuster ask questions about the nature of the injury in terms of causality. This is used to 1) determine whether the employer is responsible (the injury was caused by the work) and therefore the claim is compensable, and 2) if there a any shared responsibility with the patient or other entities, such as the maker of equipment the patient was using (apportionment). If the patient has already received treatment, but the case is in dispute, it is possible they would like the provider to perform an Independent Medical Exam. If that is the case, the provider is typically expected to generate a narrative consultation-style report and potentially assess prior patient records. They may be asked to provide a functional capacity assessment or permanent & stationary status. These rates are usually negotiated. The treating physician may also be asked to do an Impairment Evaluation (99455) when the patient has achieved MMI. This can be billed on a CMS-1500 or a WC-20.
 
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