Orthopedic Coding Alert

Question: What is the best way to deal with workers compensation carriers who require, after each visit, an update to the office, the case manager and the claims adjuster? We would like to have only one update called per visit.

Brenda Davis
Lynchburg, Va.

Answer: Supplying multiple copies of office encounter notes to the clinical, clerical and claims processing personnel of a workers compensation payer is an administrative burden that most orthopedic practices could do without. Unfortunately, it is often the cost of doing business with a particular carrier and must be accepted if your office wishes to continue its relationship with the insurer. If your practice has a contract with the carrier, review the contract to see if there are specific requirements regarding the documentation you must provide. If you are contractually obligated to supply patient updates to case managers, claims adjusters and office staff, you will obviously continue doing so. However, if this is not addressed in your contract, I suggest that you take the matter up with either the carriers provider relations manager or medical director. Perhaps they can designate a point person within their company who can distribute patient updates to all personnel who need them.

In situations when you do not have a contract with the carrier, you are obligated to abide by the workers compensation laws of your state. Review these to determine if there are any statutory regulations on documentation. In the absence of such regulations, you will need to negotiate a mutually agreeable compromise with the carrier(s). Obviously, you will want to be most accommodating to the insurers that direct many patients to your practice.