Worker’s compensation or worker’s comp refers to an insurance type that provides coverage for any job-related injuries. Although most types of medical insurance are automatically processed, worker’s comp claims still require manual processing. That’s because of the higher level of oversight needed to distinguish between a job-related injury and other types of injuries. Below, we explore the steps involved in a medical billing procedure for worker’s comp.
Filing the Claim
When employees get injured at work, the claim is typically filed through the employer’s workers’ compensation carrier. The employer’s involvement in the matter is generally handled by the HR department, although you can also administer your workers’ compensation policies. Keep in mind that workers’ comp claims don’t allow for electronic submission. That’s because the claim is always attached to notes provided by the health care provider, which document the employee’s treatment as outlined by the claim.
After the claim is filed, the affected employee gets a claim number which is the identification number they will use when receiving financial compensation for their treatment. The employee will be assigned an adjuster that authorizes the treatment, monitors the recovery process while also coordinating the claims process.
As mentioned earlier, the injured employee only becomes the healthcare provider’s patient after the adjuster authorizes the treatment. Claims that are made to government health care plans are until the carrier confirms that the workers’ comp will cover the cost of a particular treatment.
The workers’ comp covers some services that won’t be billed to the employee’s private insurance. The healthcare provider will liaise with the adjuster to come up with a comprehensive and effective treatment plan for the employee. However, if the employee gets extra treatment unrelated to the workplace injury, then the cost will be billed to their private medical insurance.
Processing the Claim
The adjuster will check the claim form and the attached healthcare provider’s notes to confirm that the treatment received by the patient is in line with the authorized treatment plan. If the employee receives unauthorized treatment related to their workplace injury, they won’t be held liable for these expenses.
The medical billing procedure for worker’s compensation can be complicated, but the guidelines in this article will help you along the way. Keep in mind that OSHA requires that businesses keep employee medical records for at least 30 years if the employee has been exposed to toxic or harmful substances. So, be sure to store all your medical billing records properly.