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Workers Compensation Billing

  1. #1
    Question Workers Compensation Billing
    Medical Coding Books
    Is there anyone doing Workers Comp billing in CA? Can you please verify if you can bill the patient legally if the insurance denies and the employer refused to pay?

  2. #2
    Location
    Kansas City, MO
    Posts
    431
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    I'm not in CA... I would say it depends on the reason for the denial, but more than likely Yes, you should be able to bill the patient. Do you have your patients sign any kind of financial agreement when they first come in? Maybe something about this in your consent for treatment? The patient asks for services/treatment, then they should be responsible for payment if the insurance denies. (Unless there is some reason on the offices end that caused the denial???)

    I cant imagine that any state would have a law saying if the ins didnt pay, oh well to bad.

    Why did the ins deny? Pt may need to pay and in the meantime appeal to get their money back.
    Linda Vargas, CPC, CPCO, CPMA, CPC-I, CEMC,CCC
    PMCC Licensed Instructor
    Kansas City, MO Chapter
    President, 2018
    Vice President, 2017
    Member Development Officer 2016
    Harrisonville, MO Chapter President - 2013
    ICD-10 Education Coordinator- 2012
    Chapter President - 2011
    President Elect - 2010

  3. #3
    Location
    Columbia, MO
    Posts
    12,531
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    Why did WC deny the claim?

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Location
    Kingsport, TN
    Posts
    149
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    If the claim denied due to not work related or patient had a positive drug screen then this would not fall under the workers' comp laws and therefore you would bill the patient. I don't know the particulars of your denial but this is just my thoughts.

  5. #5
    Location
    Columbia, MO
    Posts
    12,531
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    That was why I asked with Ca work comp there are a lot of hoops to jump through and if you miss one then they will deny, I have done a lot of CA work comp billing.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
    Default
    yes we do have a consent form that the patient signs, I just want to be clear on it. California is tricky and there is alot of hoops, its never black and white. Ok thanks for your help.

  7. #7
    Default
    Quote Originally Posted by llharg View Post
    Is there anyone doing Workers Comp billing in CA? Can you please verify if you can bill the patient legally if the insurance denies and the employer refused to pay?

    1st of all, is your practice specialize in WC? if WC denies pmt, submit that eob to to health ins. They suppose to pick up the bill. If not, you can file lien to WC board and wait for the hearing. it takes very long time to resolve your lien.

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