Medical Billing Woes? Here're Five Ways to Ease the Pain of Billing Workers' Compensation

Not having relevant patient information before attending to the patient? Well your medical billing process could invite trouble.

Processing workers' compensation claim may give you a harrowing time. Here are some guidelines to stay clear of them all.

Issue: One of the key points of uncertainty is that, while workers' compensation is authorized with federal guidance, it's a state-run program. This is to say that each state comes with its own rules, fee schedule, and process. What's more, add in the fact that federal and railroad employees have their own workers' compensation (WC) programs and you might have a difficult time.

Here are five expert tips to help your practice toward clean WC claims:

Get all relevant claim info before the patient steps in:

Start your work on a WC claim even before the patient arrives at your office. When a patient calls to fix his first appointment for an injury that could have been on the job, say for instance sprained back, the first thing your staff members should ask is whether this injury was work related.

If so, you should gather as much relevant information as possible over the phone.

Train eyes on the state the claim originated from


Oftentimes a patient will sustain an injury in one state, however seek treatment in another. In instances such as these, you should follow the rules for the state in which the injury took place. Train eyes on where the claim was first filed. That state will have jurisdiction over the claim.

Do not depend just on the WC Fee Schedule


You do not require the WC carrier's fee schedule to bill claims. However you may want to since you may actually boost your revenue by following their fee schedule.

Be careful treating and billing other problems

While your physician can technically and legally tend to a patient for a worker's comp visit and other problems not related on the same day, you may find it easier in the long run to keep the visits separate. Remember that you will have to send claims to two different payers if the physician tends to the WC condition and an unrelated problem in the same visit – One claim will go to the WC carrier and the other to the patient's normal insurance.

Focus on special DME Regulations

If you provide DME, you may speed through a few extra hoops to ensure you get paid for those services as well as the office visit and treatment services or procedures.

Some carriers need prior authorization for DME. As such see to it that out have these pre-authorization before dispensing. Having the patient sign an ABN often turns out to be futile.

For more online medical coding billing information, sign up for a good Medical Coding resource like SuperCoder.com.