These laws are still issued on a state-by-state basis, meaning the exact rules and regulations vary, making the workers’ comp billing process challenging from an operational perspective. Mix in a lot of paperwork and strict timelines, and these claims can become taxing for those concerned with revenue cycle management.
In workers’ comp cases, you’re dealing with a legal process alongside a medical service, essentially doubling the number of parties involved. This can make effective communication a challenge. In addition to the patient and primary provider, information needs to be communicated to the payer/network, the work comp case manager, and/or the employer. These communications must be timely and detailed because if the patient isn’t working and is receiving some form of payment, they must prove that they’re being seen by someone in order for benefits to continue, especially when it comes to outpatient cases. Every visit and every claim must be adjudicated by supportive documentation, including things such as schedules and clinical notes to show patient attendance, progress and medical necessity.
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[Editor’s Note: This article originally appeared on SourceMed’s blog].
