Workers' compensation in medical billing are provided by carriers to employers to cover treatment for illness or injuries that happen to their worker as a result of employment. As a service, workers' compensation billing entails a lot of guidelines marked by several requirements and limitations. These guidelines differ from state to state, making the processing of these services very complex. Additionally, workers compensation billing needs to be processed manually as they require greater oversight.
MediCodeBill has over 2 decades of experience in handling workers compensation billing services for its US-based healthcare providers. Over the years we have assisted our clients submit bills by following basic workers billing compensations steps such as getting proper authorization, ensuring compliant billing, maintaining the tariffs as determined by the regulatory body, documenting bills properly and submitting them electronically. As a leading workers compensation billing service providing company, we reduce the time and effort needed to obtain proper reimbursement.
This is a very critical part of workers billing and entails proper and correct input of information. Unless done correctly it may lead to denials. We ensure that important information such as injured worker's name, mailing address and date of birth, current claim number, date of injury, area of injury and diagnosis, date of initial and subsequent visits, tariff codes and fees, WCB account number, including address, fax and phone and fax number are properly included. After the information is included, we cross check it for accuracy.
Once the processing of remittance is done a statement is issued by the carrier. We review the statement to ensure the details of what was paid to an injured worker is correct with what was submitted. This review of statements helps our clients reconcile their records
If claims are denied, we assist you with handling denials. We first try to establish the reason for denial and if it happens to be a case of mistaken paperwork, we contact the claims adjuster to clarify the problem and resubmit claims. If the insurance company refuses to accept the mistake, we assist our clients get in touch with an attorney to appeal the denial of the claim. In case it doesn't work out we assist our clients with additional levels of appeal depending upon the state rules
The fees for medical aid is determined by the WCB's legislative authority and is different for different practices. Each service provided to an injured worker has a different tariff. Most of these tariffs are specific to the WCB. We help you understand these specific tariffs which includes physician tariffs, chiropractor tariffs, physiotherapist tariffs, pharmacies, nurse practitioner tariffs, vendors and hearing aid clinics tariffs etc.
We also assist our clients in managing their entire account receivables process in order to guarantee the best outcomes for their business. Our services for end-to-end revenue management includes coding and billing, collections of outstanding, payer and patient relations, fee analysis, client reporting, review different payers for workers compensation benefits etc.
MediCodeBill has over 2 decades of experience in providing services for workers compensation billing to healthcare providers in the US. Our wide experience in handling the various complexities of workers' compensation billing will help you eliminate the difficulties faced while billing in-house and boost the profitability of your practice.
We follow a definite billing process to ensure our clients get full reimbursements.
Our workers compensation medical billing process entails the following steps.
In addition to our core offerings, we pride ourselves on delivering a wide range of supplementary services designed to meet your every need. Whether you require personalized consulting, ongoing maintenance, or specialized support, our team is equipped to provide tailored solutions that enhance your experience. We go above and beyond to ensure that all aspects of your requirements are met with the highest level of professionalism and care.
Verify Employee Credentials
Once an employee visits a medical provider to receive benefits a written notice of the injury is obtained as soon as possible from the employee or employer. At this stage we verify the injured worker's employment and injury history, on behalf of the provider.
Case Verification
After verifying employee credentials, we meticulously verify the full details of the insurance company with details on adjusters, case status, body parts, etc.
Pre-Authorization Request
In this stage, we request for authorization to kick-start the utilization review process as required by Labor Code section 4610. The request is supported with doctor's first report of occupational illness or injury, Form DLSR 5021, DWC Form PR-2, a treating physician's progress report etc. to substantiate the required treatment.
Billing and Coding
After obtaining the authorization and the treatment is carried out, we procure the medical reports to ascertain the afflicted body parts and treatment carried out. Based on the reports and procedures we carry out coding. The coding is checked for accuracy multiple times because codes for workers compensation are updated frequently.
Bill Submission
After the quality check, the bills are ready for submission on the carrier’s portal. Though regulations stipulate bill for payment within 12 months of providing a service, we ensure submission is completed soon enough for early reimbursements.
Timely follow-up
We do regular follow ups to ensure reimbursements are on time. As insurance companies need to pay providers within working 15 days of receiving a bill, we pursue a bill payment much before the deadline.
Review and Submission
In case the payer does not actually pay the full amount, we scrutinize the payment and explanation of benefits, and file the second bill review within 90 days of submission. If the bill is still not properly paid, we take all the necessary steps to initiate an independent bill review.