Get pertinent information before seeing the patient to avoid trouble when you start the billing process. Just the thought of processing a workers' compensation claim can bring on a headache, thanks to factors such as workers' compensation being authorized with federal guidance, but is a state-run program. Add individual state rules, fee schedules, and processes to the mix -- and the fact that federal and railroad employees have their own WC programs -- and you could be tempted to leave that WC claim for another day. Solution: 1. Capture All Pertinent Claim Info Before the Patient Comes In Your practice's work on a WC claim should begin before the patient even sets foot into your office. When a patient calls to schedule his first appointment for an injury that could have been on the job, such as a sprained back, the first question your staff should ask is: "Is there a chance that this injury is work-related?" If the answer is yes, collect as much pertinent information as possible over the phone. Details should include the date of injury, workers' compensation carrier, claim number, employer at the time of injury, adjuster and/or case manager name and phone number, and alternative private insurance information. Watch out: Pointer: After getting the information from the patient, you need to get in touch with the WC insurance company to obtain authorization to treat the patient before the initial visit. "A phone call to the WC carrier is a good idea, before the patient is seen," explains Linda Huckaby, CMA (AAMA), with Carolina Medical Rehabilitation in Greenville, S.C. Ask: "Is this really a WC case? Is our office authorized to see the patient? Is a pre-authorization required for each office visit? Who is the adjuster or case manager?" she adds. Good practice: 2. Focus on the State Where the Claim Originated Many times a patient will sustain an injury in one state, but seek treatment in another. In these cases, you should follow the rules for the state in which the injury occurred. Focus on where the claim was first filed because that state will have jurisdiction over the claim. Problem: "When we have had this situation come up, we are bound by the rules of the state where the accident occurred," Huckaby confirms. Example: "The California provider needs to understand which state regulations now apply -- is it going to be California because they're now being treated in California or is it going to be Ohio," Hammer explains. "In most cases, it's going to be Ohio." Good news: Next month: