PD-311 Worker’s Compensation for Billers

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in -service on worker's compensation

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PD-311 Worker’s Compensation for Billers :

PD-311 Worker’s Compensation for Billers West Valley Educational Group, LLC

DESCRIPTION :

DESCRIPTION This in-service provides a basic understanding of Worker’s Compensation and processes for completing and submitting insurance claims. Prerequisite: None

Worker’s compensation:

Worker’s compensation Each state has its own Worker’s compensation laws pertaining to handling claims from employees who are injured on the job. To qualify for worker’s compensation, the injury or illness has to be incurred in the course of employment in order for the workers' compensation system to provide benefits to the injured worker.

Worker’s compensation:

Worker’s compensation It is typically required by the state for every employee; however, some employers such as small companies with fewer than five employees, farmhands, domestic workers and independent contractors are exempt from this requirement.

Worker’s compensation:

Worker’s compensation There are 2 types of Worker’s Compensation benefits Benefits to cover medical expenses 2. Benefits to cover loss wages

Worker’s compensation:

Worker’s compensation Worker’s Compensation medical benefits will cover injuries, illnesses and job-related deaths. The injury may not be limited to accidents on the job. There may be an instance where the employee has an off-site injury while driving to the bank to deposit checks; this will be covered under Worker’s Compensation.

Worker’s compensation:

Worker’s compensation When an employee is injured on the job, the injury must be reported immediately within a specified time period. Check with your individual state to see whether the report must be submitted in writing. After the employer is notified, the employer must notify the state worker’s compensation officer and insurance carrier.

Worker’s compensation:

Worker’s compensation An insurance adjuster may be assigned to the case to oversee treatment and payments to the patient through weekly monetary benefits and payments to the physician

Worker’s compensation:

Worker’s compensation In some cases, the employee must see an employer selected physician. The physician of record is the physician who will provide treatment for the employee’s injury or illness. Each time there’s a change in the employee’s condition, it is reported to the insurance carrier. The physician of record will also submit a claim for services rendered

Worker’s compensation:

Worker’s compensation Under state law, either the physician of record or the employer must submit a First Report of Injury. This form must be submitted within a specified time frame. Once the first report is filed, the claim will be assigned a special claim number. Once determined the claim is eligible for compensation. If the claim is denied, services may be billed to the employee’s own health insurance.

Worker’s compensation:

Worker’s compensation When working with worker’s compensation claims, you will need to input more information than other routine claims.

Tips for Submitting Worker’s Compensation Claims :

Tips for Submitting Worker’s Compensation Claims 1. Include date of first injury/illness. Failure to include this date could delay claims processing or even denying claims. When a patient makes the appointment for the first visit, you want to obtain authorization to be sure your office is able to treat the patient. 2. Employee’s signature is not required on billing forms

Tips for Submitting Worker’s Compensation Claims :

Tips for Submitting Worker’s Compensation Claims 3. Include the worker’s compensation claim number on all claims submitted for reimbursement 4. Keep a separate file in the billing system for all worker’s compensation related visits. 5. Once the claim is paid, the physician MUST accept as payment in full . You may not balance bill the patient or employer for any medical expenses.

Tips for Submitting Worker’s Compensation Claims :

Tips for Submitting Worker’s Compensation Claims 6. Keep the name of the worker’s compensation claims adjuster for communications regarding claims status. 7. Obtain a fee schedule and/or provider handbook if available from worker’s compensation insurance carrier.

Worker’s compensation:

Worker’s compensation To avoid fraud and abuse charges, the medical office must make sure all treatments and communications are documented in the patient’s medical record. The physician of record must certify that he/she personally performed an evaluation to validate the work related injury.

This concludes this presentation :

This concludes this presentation Please complete the short quiz You can print your certification of completion upon passing with at least 80%

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