How to improve Workers Compensation Billing Services
Every employer in the US is bound by federal and state laws to have workers’ compensation insurance so that their workers would at least have some form of protection in the event of sustaining injuries or illness. But what happens if a healthcare provider is treating a patient for a condition developed from work without bringing attention to whether it’s a job-related injury or not? This adds another layer of problem.
In these scenarios, the healthcare provider is required to first bill for the services rendered to their patient’s primary insurance. If the patient requests workers’ compensation after disclosing that the condition was work-related and should be compensated for, the healthcare provider must adjust the billing process accordingly.
In case, if the primary insurer has made any payments, there is a need to bill the workers’ compensation insurance for reimbursement. If the workers’ compensation claim is denied, medical billers file a due process claim and carefully make reimbursement.
Imagine a different scenario in which a worker who has gotten injured at worksite has enrolled and wants to get off the service orthopedically but has an additional condition that needs to be addressed.
It is crucial for the provider to have the two matters resolved separately while following careful record maintenance for the benefits of both compliance and clarification.
Read below some of the recommendations on how to manage workers’ comp billing efficiently:
1. Understand the Workers’ Compensation System
Providers must have knowledge of how workers’ compensation works. Knowing the federal and state billing laws is important to get it done right. Knowing the order of events surrounding an injury and its settlement can aid healthcare providers in their future billing processes.
For instance, California’s workers’ compensation system is under the supervision of the Division of Workers’ Compensation, so contacting the division’s representatives would ensure the injured workers’ practices are well protected.
2. Verify Eligibility and Coverage
Before beginning to render services, start by ensuring the patient fits the criteria to avail of workers’ compensation benefits. Verify that the injury or illness resulted from the patient’s work and that their employer carries workers’ compensation insurance.
This step ensures proper billing and guarantees payment for the required services. For instance, in case a construction worker hurts his back while at work, the employer’s compensation insurance should reimburse his medical expenses.
3. Document Everything
Documentation is critically important in workers’ compensation billing. It is essential to record all circumstances of the injury, with emphasis on the relationship to the employment of the injured patient. Also, include all managed conditions, diagnoses, medications, and therapies. Adherence to documentation also enhances different aspects of claims and yet minimizes hurdles in the process.
For example, if a worker sustains an injury at the workplace, such as a fracture on the arm, then the medical record should record the extent of the fracture, treatment given, and further procedures or instructions given.
4. Use Correct Medical Codes
Workers’ compensation coding requires considerable attention to detail when it comes to billing the services. Medical coders should select the correct codes assigned to the type of injury or illness, as well as to any treatment or procedure properly carried out.
Correct coding improves the likelihood of claim approval and fair reimbursement. For instance, the ICD code for work-related back injury is S39.012A: strain of muscle, fascia, and tendon at lower back.
5. Submit Accurate Claims
Accurate claims decrease the chance of delayed or denied claims. Make sure all the needed information is on the claim form with the patient’s information, diagnosis, procedure codes, and provider information. If you double check the accuracy and completeness before submission, errors will be minimized and billing will be faster.
6. Stay Proactive in Follow-Up
Proactively track the progress of workers’ compensation claims. Regularly monitor the claim status and follow up with insurers to resolve any discrepancies or delays. Timely follow-up can expedite reimbursement and ensure that no claims are overlooked.
7. Leverage Technology
Providers should adopt technology solutions to streamline workers’ compensation billing. Electronic practice management software, among other things, can automate administrative tasks, improve efficiency, and give you real-time insights into claim status and reimbursement trends.
8. Outsource Billing Services
Managing the complexity of the workers compensation billing process can be helped by outsourcing the billing to the expertise of professionals. The nuances of workers’ compensation claims are familiar to specialized billing services, which promise accuracy of payments, compliance, and timely reimbursement. Providers can improve patient care and revenue cycle management by transferring billing duties to specialized experts.
If providers work through these steps, billing for workers’ compensation hospital services is smooth, and reimbursements are quick and accurate.
Final Note
Outsourcing workers’ compensation billing to a seasoned medical billing service provider such as MedBill collection who is adept at managing workers’ compensation claims offers the best one-stop solution. These services boast deep expertise in how to handle complex billing procedures, process accurately, in compliance, and for timely reimbursement.
Medical billing services serve to offer outsourcing options that may free the providers from the responsibilities of patient care and entrust all related billing tasks to dedicated professionals who streamline revenue cycle management.
