Practice Management Alert

A workers' comp fee schedule can help you recoup $100

The guidance and fee schedules you need to bill workers' comp correctly can be surprisingly hard to find if you don't know where to look.
 
The main reason for confusion is that workers' compensation, while authorized with federal guidance, is a state-run program, says Curtis J. Udell, CPAR, CPC, CMPA, senior advisor with Health Care Advisors Inc. in Annandale, Va. Each state has its own rules, fee schedule, and setup for what providers the patient can see and is required to see, says Marvel Hammer, RN, CPC, CHCO, owner of MJH Consulting in Denver. In addition, federal employees and railroad employees have their own workers' comp programs, Hammer adds.

Here are five frequently asked questions -- with answers from the experts -- to help clear the confusion surrounding workers' compensation billing.

Q: Do I have to bill according to the worker's comp fee schedule?

A: You don't need the workers' comp fee schedule to bill claims, but it's advisable "if you want to set your fees optimally for all payers," Udell says. Workers' comp programs often pay fairly well, so you may actually increase your revenue by following their fee schedule, he adds. For example, you might normally bill $200 for a procedure but discover that the workers' comp fee schedule will reimburse you $300.

For practices that see a fair percentage of workers' comp patients, you should know the fee schedule for your state and any nearby states whose claims you sometimes deal with, Hammer says. Big carriers sometimes process your claims in another state, and reimbursement can be incorrect because their computers are dealing with several state fee schedules. Having knowledge of your state's fee schedule allows you to make sure you get paid what you deserve, Hammer adds.

Q: If more than one state is involved in a workers' comp case, which state's billing rules should I follow?

A: You need to follow the rules and fee schedule of the state in which the worker's comp claim was originally filed,  Hammer says. This may or may not be the same as the patient's current state of residence, she adds. Billing can get complicated when you're dealing with truck drivers and other mobile professionals because a patient may initiate care for an injury in a state other than where he lives.

Remember: Focus on where the claim was first filed. That state will have jurisdiction over the claim. The only exception is workers' comp for federal employees, which has nationwide rules. Workers' comp for railroad workers is a mix -- most states abide by nationwide rules, but some states have their own.

Q: Should I code any differently for workers' comp claims?

A: Generally, no. However, [...]