{"id":4821,"date":"2013-02-07T17:12:23","date_gmt":"2013-02-07T22:12:23","guid":{"rendered":"http:\/\/www.poweryourpractice.com\/?p=4821"},"modified":"2025-07-01T11:49:20","modified_gmt":"2025-07-01T11:49:20","slug":"improving-workers-compensation-collections","status":"publish","type":"post","link":"https:\/\/carecloud.com\/continuum\/improving-workers-compensation-collections\/","title":{"rendered":"How to Improve Your Workers\u2019 Compensation Collections"},"content":{"rendered":"<p>Workers\u2019 compensation collections can seem like a stress-induced migraine for providers. Between special terminologies, unique collection forms, and legal obstacles, many practices don\u2019t have the resources or know-how to properly bill a worker injury case.<\/p>\n<p>So PYP is here to ease your worries and provide some simple steps to improve your returns on workers\u2019 comp claims.<\/p>\n<p><strong><!--more--><\/strong><\/p>\n<p><strong>Learning the Basics<br \/>\n<\/strong>Because it\u2019s actually a legal process with a medical delivery component, workers\u2019 comp can be very confusing. Knowing a few background guidelines can significantly help you along the way.<\/p>\n<p>\u201cThe workers\u2019 comp world has always been somewhat problematic for practices and physicians. There are a lot of things being done right now to help resolve those issues,\u201d said Don St. Jacques, Senior Vice President at Jopari Solutions, Inc., a medical billing firm specializing in workers\u2019 compensation and property casualty claims.<\/p>\n<p>Workers\u2019 comp provides coverage for wage replacement benefits, medical treatment, vocational rehabilitation, and other benefits to employees who are injured on the job or contract an occupational disease.<\/p>\n<p>According to St. Jacques, it equals 2-3% of all medical spending and represents 100 million <a href=\"https:\/\/www.carecloud.com\/continuum\/7-ways-to-enhance-your-medical-billing-process\/\">billing transactions<\/a> a year. That\u2019s no small potatoes.<strong>\u00a0<\/strong><\/p>\n<p><strong>Group Health vs. Workers\u2019 Comp<br \/>\n<\/strong>It\u2019s important to note that while the policyholder is usually the patient in the group health world, the employer is the subscriber in the workers\u2019 comp sector.<\/p>\n<p>Also, what has normally termed an explanation of benefits (EOB) in a patient-insured claim is an explanation of review (EOR) in a workers\u2019 comp case.\u00a0 And instead of identifying a claim through your regular healthcare identification number, you use a case file or claim number in its place.<\/p>\n<p>Let your staff know that there is no deductible or copayment linked to workers\u2019 compensation claims. Providers must accept the compensation payment as paid in full because <strong>billing the injured worker for any outstanding balance is illegal.<\/strong><strong>\u00a0<\/strong><\/p>\n<p><strong>Nuts and Bolts of Billing<br \/>\n<\/strong>Billing for workers\u2019 compensation claims varies from state to state. Knowing your state\u2019s guidelines will keep your practice in compliance and allow for better payments.<strong>\u00a0<\/strong><\/p>\n<p>Always keep in mind that <a href=\"https:\/\/www.carecloud.com\/continuum\/14-best-practices-hipaa-compliant-staff\/\">HIPAA privacy rules<\/a> must be followed at all times, so be careful never to bill illness and injuries unrelated to a worker\u2019s compensation claim to an employer.<\/p>\n<p>If a patient comes in to treat an injury but doesn\u2019t mention that it occurred at work, your practice might go ahead and bill his or her primary insurance. However, when the patient later requests that his or her employer\u2019s insurance be charged for the medical services, <strong>it is your practice\u2019s responsibility to re-bill the workers\u2019 comp insurance and return the original reimbursement to the primary payer<\/strong>.<\/p>\n<p>It\u2019s also important to fill out the proper forms when billing for workers\u2019 compensation. <strong>These forms include the First Report of Injury Form and CMS-1500 claim form.<\/strong><\/p>\n<p>The doctor should complete the First Report of Injury Form when the patient first seeks treatment for a work-related illness or injury. This form differs by state.<\/p>\n<p>The billing department will then need to attach a <a href=\"http:\/\/www.cms.gov\/Medicare\/Billing\/ElectronicBillingEDITrans\/16_1500.html\">CMS-1500 claim form<\/a> to the physician\u2019s documentation in order for the workers\u2019 compensation insurance to properly remit payment. Make sure to include the date of injury on the CMS-1500 as it is often overlooked.<\/p>\n<p>\u201cIt\u2019s absolutely critical when the information is delivered to payers that it contains not only the substantiation of the charges but also all of the other findings and results,\u201d said St. Jacques. \u201cThose two things combined will drive the reimbursing and disposition of the patient.&#8221;<\/p>\n<p>Follow these simple steps and you should see an increase in workers\u2019 compensation payments. Although it can be a bit problematic, there is no reason why your practice should be eating workers\u2019 comp costs.<\/p>\n<p><strong>Have you encountered problems with workers\u2019 comp or other special claims? Let us know your situation and maybe we can feature your problem in our next article.<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Workers\u2019 compensation collections can seem like a stress-induced migraine for providers. Between special terminologies, unique collection forms, and legal obstacles, many practices don\u2019t have the resources or know-how to properly bill a worker injury case. So PYP is here to ease your worries and provide some simple steps to improve your returns on workers\u2019 comp [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":32788,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4],"tags":[],"class_list":["post-4821","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-revenue"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Improve Workers&#039; Comp Collections - CareCloud<\/title>\n<meta name=\"description\" content=\"Workers compensation collections seem like stress-induced migraines. 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