Practice Management Alert

Match your responses from the quiz against these answers

Answer #1: You don't have to use the workers' comp fee schedule, but it may help keep your fees optimal for all payers. Many workers' comp programs pay considerably well, so your reimbursements could increase if you choose to follow that fee schedule instead.

As for coding, workers' comp claims are no different from your standard payers' claims. Some states may not use current-year CPT codes, however, so check with the carrier if you've received unfounded denials. Most important, you should always use E codes to explain the patient's injury and the surrounding circumstances. If a patient has more than one injury claim in the workers' comp system at the same time, E codes will allow the carrier to differentiate claims and pay without delay. Answer #2: When a patient schedules his first appointment for an injury that could have been on the job, such as a sprained back, the receptionist should always ask whether the injury is work-related. If the answer is "yes," the receptionist should collect all pertinent billing information such as date of injury, workers' compensation carrier, claim number, employer at the time of injury, claims adjuster and/or case manager name and phone number, and alternative private insurance information. Also, obtaining authorization to treat the patient before you see him helps ensure reimbursement. Answer #3: You must follow the billing rules and workers' comp fee schedule of the state in which the first workers' comp claim was filed. Workers who are mobile, such as truck drivers and traveling salesmen, are more likely to begin care for work-related injuries in states other than where they live. Workers' comp for federal employees is the exception, because there are nationwide rules. Answer #4: Although medical necessity may require the physician to treat unrelated problems during a workers' comp visit, the best scenario is to have the patient return for a separate appointment to address other nonrelated problems. Having a clear and separate record for your workers' comp claim will help reduce carrier confusion and expedite payment. In fact, you should keep all workers' comp and motor vehicle accident records separate from the patient's other records. Confirm Your SNF and Consolidated Billing Skills Answer #5: You should develop a short, one-page contract to ensure your SNF payment. Providers should always take the contract with them on SNF visits and have an administrator sign the document. The contract should list the physician's billing information and include a disclaimer stating that you expect payment for services rendered regardless of the SNF's reimbursement status with Medicare. A contract may not prevent all problems, but it will give you legal means for pursuing payment if the SNF refuses. Answer [...]