What to Consider When Streamlining the Workers’ Compensation Billing & Collection

Maintaining an efficient medical billing workflow management while streamlining the workers’ compensation may be a tough nut to crack for many healthcare providers. However, experienced medical billing agencies take particular measures to enhance the significant workers’ comp collections. These measures also influence the healthcare RCM. In addition, workers’ compensation regarding state laws demands the latest knowledge and keen attention to detail. That’s why it is crucial to ensure billing is accurate enough to get the most out of them. Therefore, this must be the major noticeable point of every medical practice.

Since the regulations kept on changing and updating frequently. It has become so hard for the providers to manage the worker’s comp collections. Following are the top challenges that the practices face in optimizing no-fault or workers’ compensation medical billing services.

Lack of ERA/EFT

Electronic reimbursements could be a way to streamline the billing cycle smoothly. But, the regular billing procedures and worker compensation collection processes both are different from each other. In this event, it is noted that for both of them the ERA (electronic remittance advice) & EFT (electronic funds transfer) setup is not present. The medical professionals spend unnecessary time on manual labor thereby missing out on the simplicity of electronic reimbursement procedures.

Different Payer Network

Right when the healthcare services are given to the patients the issues of collections begin to rise. In the situation, workers get injured on the job & if staff have various insurance networks in charge of the healthcare service payments. The person who gets injured must tell the details to the billing teams so they can proceed with accurate information that he/she gets hurt due to a work-related matter. It results in the administration billing to the primary payer network if you fail to mention this significant information. It will delay the reimbursements and cause unnecessary confusion for the medical facilities.

Lagging Understanding of State Regulations

When it comes to collecting and invoicing no-fault or workers’ compensation billing are challenging areas in medical billing. Through the guidelines and policies, the insurance agency is maneuvering due to increasing government regulations. Your administrative teams must stay up-to-date with the latest government regulations and modifications in the procedures. Oftentimes, it becomes so daunting to keep with the intricate details due to a lack of proper training and a hectic schedule. This remains a big issue for those healthcare organizations managing billing procedures manually.

Inconsistent A/R Follow-Ups

As the mainstream collection process and the worker compensation collection is different from each other. It needs a dedicated team to generally manage the A/R follow-ups. The medical practices lack the staff and required assets to keep a follow-up with the payer networks. Eventually, this will drown the financial stability of a healthcare business, harms the revenue cycle, and the number of days in account receivables. 

Maximizing Collections & Reduce Stress 

Providers may see workers’ compensation collections as a stressful task. Between legal barriers, special procurement forms, and specific terminology, many providers don’t know how to properly bill a workers’ compensation case as they have no sufficient resources. Remember these steps just in case while streamlining the no-fault or workers’ compensation medical billing services & collections;

  • The professional must verify the injury history and employment of the injured worker while managing the new intake. A choice can be made on the spot if the case does stand in the Workers’ Compensation Appeals Board.
  • During delivering the healthcare services to patients, make sure you are taking every detail of the insurance agency with data on case status, adjusters, body parts, etc.
  • Accurate coding has vital importance. The Division of Workers’ Compensation now follows the Centers for Medicare & Medicaid Services. Codes are updated daily. So, before submitting the bill to payers for payments coding must be checked to ensure complete accuracy.
  • Reporting is a significant step to consider. An accurate medical report must include the treatment plan, history of the body parts, injuries or injury you are treating, or recommendations of future treatment, etc.
  • The RFA for healthcare treatment is necessary for the worker’s treating professional to start the process of utilization review. Form DLSR 5021, DWC Form PR-2, physicians’ first report of occupational illness or injury, a treating doctors’ progress report, and other supporting reports must be attached substantiating the requested treatment.
  • A physician must submit claims for reimbursements within a year of rendered services. However, this requirement is not applied to the date of service before 01/01/2022.
  • Within the next two weeks of receiving a properly submitted digital bill, the payers should pay providers. If payers do not reject an accurately submitted claim and fail to pay they have to pay it with interest and penalty.
  • Regulations are updated, though for the profit of physicians however, payers do not pay the balance that professionals are owed. It should be evaluated as soon as it receives the EOB & payment, and within 90 days of submission must file the Second Bill Review, following with the independent bill review if still not reimbursed properly.
  • The last resort must be litigation. Besides, the providers should file their lien in eighteen months from the service’s last date when other efforts have been of no results so that it couldn’t violate the laws and limitations.
  • A medical professional must increase their efforts to get the reimbursements due at the event as the revenue is pending for a long time. This due money needs efforts to contact defense attorneys, supervisors/adjusters, or proceed to Lien Trial or Conference.
  • Payers generally prove that according to the Official Medical Fee Schedule they have paid the providers. At this point, you must review the bill to check if you collect for what was due.

If your practice handles Workers’ Compensation cases, feel free to reach out to GreenBills for a Free Consultation.

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