Another set of instructions or guidelines have been set by the billers and medical coders which affect their work, Workers Compensation. The Compensation of workers carriers underwrites plans and policies that employers carry to cover treatment for wounds or sickness that occur as an outcome of employment.
Processing the Compensation of workers claims adds still another layer to the already teetering tower of things you require knowing as a coder.
When you are addressing the Compensation of Worker services, remember the following points:
- Claims of Workers’ Compensation are normally particular regarding which diagnosis code and body part are authorized for the specific treatment. In short, workers might have several claims, with a distinctive claim number for each body part.
Always check the approved diagnosis and body part linked to the claim number when verifying the claims of workers’ compensation prior to an encounter.
- Treatments of Follow-up might be part of the claim. For this very reason, inquire for documentation of the background of a specific sickness or injury.
- Sometimes, the carrier of Workers’ Compensation subrogates a claim with the commercial insurance of sufferer and generally reimburses the commercial insurance for a claim paid in error. This type of action is not fair to the provider because the carrier of Workers’ Comp benefits from a contracted discount that should not have been utilized to price the claim. Make certain you catch errors of this nature before any outside negotiation appears between the carriers.
- Certain carriers of Workers’ Comp are part of a PPO network (or various networks). For your sanity, make certain that your PPO network contracts don’t permit silent PPO access. Considering out how to manage the claims of Workers’ Comp is challenging enough; a silent PPO situation just slows the procedure.
Certain states have laws of Workers’ Compensation that serve as contracts for any provider who gives services under the proposed claims filed in that state. This is believed to be another factor to consider when discussing a PPO network contract. Verbiage that details a discount is implemented to the fee schedule instead to the billed charges stops double discounting.