Practice Management Alert

Question: We are having trouble with a claim for a motor vehicle accident (MVA) patient. The denial stated that we billed the wrong insurer--apparently, the patient's workers- compensation insurer was the proper payer. Would you offer advice on how to avoid MVA claims confusion?


Minnesota Subscriber


Answer: Next time, you should ask the patient some insurance questions before you complete the claim. When an MVA victim presents, ask if the MVA was work-related. If the accident happened on the job, the patient probably has a workers- comp package that will cover the accident expenses.
 
When a patient affirms that her MVA happened while on the job, find out the specifics of her workers- comp plan and file the claim accordingly. This is the information you-ll need from the patient's workers- comp plan:

- name and phone number of claim adjuster
- date of accident
- claim number and policy number
- verification of deductible information
- preauthorization of treatment. If the patient's MVA was not work-related, you should ask for all the above information--but from the patient's motor-vehicle insurer, not her workers- comp plan.

Good idea: Verify all insurance information before the doctor first sees the MVA patient.

Vital: When billing Medicare for MVA patients, you must remember to fill out boxes 10b and 14 on the CMS 1500 form. Check -yes- in Box 10b if the patient's condition was caused by an auto accident. Under box 10b, there is a space for a two-letter state abbreviation. Be sure to write the state abbreviation where the patient's MVA occurred in this space.

For example, if the accident occurred in Ohio, you would write -OH- in the space. Box 14 calls for the date of illness, injury or pregnancy. This is where you should fill in the date of the accident. 

The answers to the Reader Questions were provided and/or reviewed by Catherine Brink, CMM, CPC, president of HealthCare Resource Management Inc. in Spring Lake, N.J.