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Thread: Work Comp

  1. #1

    Default Work Comp

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    If WC denies claim, can we legally bill patient? Where do I go to find WC rules for the physician?

  2. #2


    Not sure where you could find rules but yes, if they deny you can bill pt. Same w/ auto's.

  3. #3



  4. #4
    Join Date
    Apr 2007
    Columbia, MO


    I think it depends on what the denial is for. If the provider did not bill the claim correctly then no it cannot be billed to the patient. Your work comp rules can be found in your state. most are on the state work comp web site. Work comp is not a HIPAA entity and do have to use the HIPAA mandated code sets for the CPT or HCPC codes. Many times they do not use the current year and many I have worked with are several years behind. This means if you are using current codes they will deny the claim for invalid code if that code does not exist in the version they are using. Can you bill the patient then? No you cannot as you did not follow work comp rules. I have found that when you follow the work comp rule for coding and you have the incident report of the incident then they pay. So I am saying no you cannot bill the patient until you determine what the problem is.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Join Date
    Apr 2007


    you can not bill patient either if they have an attorney

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