Wiki workman comp follow up

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swright01

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Hi team i am trying to write a policy and procedure for my team on how to work w/c claim or follow? Does anyone have any suggestions, right now i have these items listed

Detail information rep needs to review is the date, time and location of the accident

Ensure the injury is work-related (ex- ICD- 10 and CPT codes specific to w/c injury)

Confirm all required documents were sent to the w/c carrier

I truly appreciate any input

Shirley
 
In our office if the patient is seen for personal and work comp issues they have two separate accounts. We do not see any work comp patients without prior notification from the employer, phone call or fax but it has to be approved by the employer. We do not take referrals from other physician's offices without approval from the employer. We require the employer contact name, phone #, fax#, date of injury, claim # if available and if there is going to be a work comp carrier involved all from the employer. Some employers just want statements to go to them and they will file the claim,
We have had patients be seen then after the fact state it's work comp, we then send to their health insurance and the patient can work all the other details out with their employer. We had another employer state that an appointment 2 years prior should have been work comp. In those situations we tell them they will have to have work comp insurance subrogate with health insurance. We can send them a financial summary on the visit if they need CPTs and ICD-10s for the visit paid by the health insurance.
 
catherinetinkey@entmedicalservices.org said:
In our office if the patient is seen for personal and work comp issues they have two separate accounts. We do not see any work comp patients without prior notification from the employer, phone call or fax but it has to be approved by the employer. We do not take referrals from other physician's offices without approval from the employer. We require the employer contact name, phone #, fax#, date of injury, claim # if available and if there is going to be a work comp carrier involved all from the employer. Some employers just want statements to go to them and they will file the claim,
We have had patients be seen then after the fact state it's work comp, we then send to their health insurance and the patient can work all the other details out with their employer. We had another employer state that an appointment 2 years prior should have been work comp. In those situations we tell them they will have to have work comp insurance subrogate with health insurance. We can send them a financial summary on the visit if they need CPTs and ICD-10s for the visit paid by the health insurance.
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Thank you, appreciate your feedback
 
Google "medical billing work comp workflow" or a similar sentence. It will be easy to find.

It depends on the type of practice, insurance carrier (OWCP vs. a small local place, etc.), and state as well. Each one can have different processes and sometimes they have a preferred provider list and the patient may not even be authorized to be seen by your group.
 
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