Practice Management Alert

Knowing which state has jurisdiction over the claim is the key to success

If the thought of workers- compensation (WC) claims gives you a headache, you-ll want to incorporate these expert tips into your billing process to take some of the work out of WC encounters. You-re not the only one confused by WC billing complexities.

Take a look at these three common questions--with answers from the experts--to get the scoop on what you need to do to ensure proper WC claims processing. Question 1: How do I know which state's rules to follow? The biggest area of confusion is that workers- compensation is a state-run program. Each state has its own rules, fee schedule and setup for what providers the patient can see, which often leaves billers wondering where to go for billing information.

-There is no clear guideline, as it is different from state to state, contract to contract,- says Donna O-Hern, CPC, chief auditing officer at Parses Inc. in Tampa, Fla.

Bottom line: You need to follow the rules of the state in which the patient originally filed the WC claim.

Caution: Keep in mind that this may--or may not--be the same as the patient's current state of residence. You may encounter cases when a patient receives care in a state that doesn't have jurisdiction over the WC claim.

-Only one state will have jurisdiction over a workers- compensation claim,- says Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting, a healthcare reimbursement consulting firm in Denver. -It is typically the state in which the claim was initially filed. So there shouldn't be situations when more than one jurisdiction is involved in a claim.-

Test yourself: A patient suffers an injury in Colorado and files a claim with Colorado. Then the patient moves to Florida and receives care in Florida for the Colorado WC claim. Which state's WC regulations apply to this patient's treatment?

Colorado rules apply to this WC claim rather than Flor-ida, Hammer says, because the claim originated in Colorado.

Exception: The only exception is WC for federal employees, which has nationwide rules. -Federal WC jurisdiction covers all federal employees regardless of where the injury occurred,- Hammer says. -For example, a postal worker in New Hampshire is injured on the job, and he files the initial claim with federal WC and not New Hampshire WC. Since this is a federal employee with a work-related injury, federal WC rules/regulations cover this injury regardless of where the patient is injured or receiving care.- On [...]