When you are billing a Workers’ Comp/PIP Claim, your success cautiondepends in part on whether your office captures all the pertinent information up front. When the patient first walks in and fills out the paperwork related to WC/PIP claim, often times it is incomplete, and/or illegible. Result – Confusion and delay in claims processing. By following these simple tips, you can avoid unnecessary delays in claims processing.
1. Obtaining accurate and complete information is not only vital in terms of billing the claims but also in providing the necessary medical care to the patient. This collection of the data begins at the front desk. A little diligence at the initial stage can save a lot of headache afterwards. When dealing with WC/PIP cases, the front office should thoroughly verify the case details. Make sure –
- That the patient has completed an Accident Report also known as First Report of Injury [in case of WC to the employer and in case of PIP to the No-Fault carrier].
- Claim has been logged with the insurance carrier and a claim no. has been assigned to the case.
- Patient’s questionnaire is filled out and has been received by WC/PIP carriers.
- In case of PIP cases, if the carrier has requested for an affidavit of ‘No Insurance’, make sure that it has been received and acknowledged by the PIP carrier.
Often, you will come across a situation where patient, in need of urgent medical treatment has either contacted the provider directly or contacted the attorney who has sent them to providers for treatment and neither the employer (in case of Workers Compensation) nor the No-fault carrier (in case of Motor Vehicle Accidents) have been informed about the injuries. Reporting the accident/injury is very important as sometimes there are limitations placed on the completion of the First Report of Accident/Injury. In such cases, it is very important to contact the Employer/No-fault Carrier and patient must be made aware of this situation.
2. Once this initial process is over and you have received the Accident Report from the patient and/or attorney, review the report to make sure you have all the information needed to file the claim. This part is very important as sometimes things are overlooked. If any of the information is missing or not verified, this could create a lot of agony and pain at the time of filing the claim. Make sure the accident report has following information:
- Name, Address, Telephone Number of Worker’s Compensation Insurance/ No-Fault Carrier
- Date of Accident/Injury
- Claim Number assigned to the case
- Name of the Claim Adjuster handling the claim (for in-office use only)
These small but vital piece of information are very important as this goes on your HCFA 1500 or its electronic equivalent and if this information is not filled correctly or missed out completely, chances are your claim will get denied and you will have to rework again.
Note: Claims adjusters usually look for reasons not to pay the claim. Any such minor errors or incomplete submissions leave the door open for them to deny your claim. Also note that Workers Compensation and No-Fault patients usually require Pre-certification/Prior authorization for procedures/treatments to be performed. So it is also advisable to check with the case adjuster if the treatment being provided is a covered or a non covered service.
3. Once you have filed the claim, do not wait for the carrier to send you the status notification. Based on your state laws and insurance guidelines, simply pick up the phone and do a follow up call. You might be surprised that your claim is simply pended for additional documentation or missing some pertinent information. This will enable you to take any appropriate action immediately and promptly.
Addressing these issues on time will speed up the process of claims handling, reduce redundant work associated with WC/PIP claims and will stop the revenue leak.