Workers compensation insurance, more commonly referred to as "workers' comp" is a type of coverage that is required by law for a…
Workers compensation insurance, more commonly referred to as “workers’ comp” is a type of coverage that is required by law for all but the smallest of employers in almost every state. It used to be called Workman’s Comp, and the term is still frequently used casually, but the program has been formally renamed to be more inclusive.
Limitations of Workers Comp Claims
Medical billing services and practitioners who manage their own physician billing need to understand how the system works to make sure that they are reimbursed for covered care. Treatment covered under workers’ comp is very limited. It is restricted to injuries or illnesses that are directly related to the job, and may only include those injuries and not other symptoms that the patient may have concurrently.
Because of the strict limitations on medical billing that qualifies under this specific coverage, there are specific billing and coding practices that are used; and unlike most other forms of insurance claims, workers’ comp claims are processed manually due to the extra scrutiny each claim undergoes. Insurance companies usually contract with large chain clinics that specialize in workers’ comp in metropolitan areas. Medical billing will often be managed internally in these big companies, but even they may hire medical billing services due to the specialized nature of these claims.
If you are in private practice as a general practitioner in a small community, or if you are a specialist who may be called upon to treat work-related injuries under a workers’ comp claim, then you will need to be familiar with the billing and coding that is specific to this kind of insurance claim or enlist the aid of medical billing specialists.
When an injured worker files a claim, they have to file it with the carrier selected by their employer. The human resources department of any company should make this information readily available to all employees because they may not be immediately available in case of an emergency. Practitioners need to make sure their office employees know how to verify that the right workers comp company has been contacted in order to avoid rejected medical billing claims.
Workers’ comp adjusters can authorize treatment by the victim’s primary care physician, but whenever they can they will only authorize the patient to be treated by a physician in the carrier’s network because they will have negotiated lower rates with them. Physicians’ staffs must verify that treatment is authorized before beginning the process of treatment against a workers’ comp claim, and then carefully follow through with the correct billing procedures so that the claim is not rejected.