in2itive’s Workers’ Compensation Claim Checklist

in2itive's Workers' Compensation Claim Checklist

Workers’ Compensation cases are often known to cause a headache when it comes to collecting; from denied claims to negotiating payment, the cycle can often seem endless.

Thankfully, our team of Workers’ Compensation experts have found the tips and tricks over time that help ensure their claims get processed and paid in a timely manner. We sat down with Linda, our go-to Revenue Cycle Specialist for Workers’ Compensation, to discuss the best practices her team implements to see improvements in their Workers’ Compensation claims.

Start at the frontline.

To ensure a smooth (as possible) process when filing your Workers’ Compensation claims, it is important to set yourself up for success from the start – when the patient walks into the surgery center. Important information can be collected upon check-in, including inquiring if the patient has an attorney involved. This information is important to help determine if your Revenue Cycle Specialist needs to reach out to the attorney to provide claims for the case to be carried out properly.

Ensure all documentation is included.

Before sending your Workers’ Comp claim, make sure you have included any operative reports, implants, and block reports to help ensure insurance pays on the proper codes. Including the block report is essential to avoid unnecessary bundling of your implants, therefore maximizing your payment. While some companies may say they don’t need the operative report, insurance may say differently; it is best to always include the implants in your claim to ensure the claim goes out clean and to avoid any potential hold-ups in processing and payment.

Sometimes, a center may dictate otherwise and ask that you include or exclude certain pieces, so include information at the discretion of the surgery center.

Don’t lack on identifiers.

When creating your claim, don’t go light on the details. If you have an incorrect claim number and insurance is unable to locate the claim, you can fall back on the patient’s Social Security Number to obtain the proper claim number associated with the case. Additional information, such as patient name, date of birth, and date of injury can also aid in finding a claim, so it is crucial to ensure all information is accurate and included. This extra checkpoint can help avoid issues of timely filing due to an improper claim number, and help reduce unpaid claims

Additionally, make sure the Office of Workers’ Compensation Programs (OWCP) number is included – this number allows the Department of Labor to properly identify the employer involved in the Workers’ Compensation claim, and claims may be held up until this information is provided.

Include adjuster information.

Another step that allows for an additional layer of protection includes providing the insurance adjuster’s name and contact information. This step ensures that, if your claim is to be sent to the wrong office, the receiving office may forward the claim along to the proper representative. Workers’ Comp claims are often received by a specific office within an agency, and even a specific often based on region, making the extra information even more beneficial in the instance of a wrong recipient.

Don’t hesitate to negotiate.

In states where there is no fee schedule, don’t be afraid to negotiate for a higher percent of payment from an insurance company. Remember, you can always ask for less, but typically not for more. Make sure to notate every interaction and discussion, creating a virtual paper trail for each Workers’ Compensation case; this will provide a solid foundation in case any pushback is received on the claim, or legal representation becomes involved through the patient.

Are you ready to step up your revenue cycle game when it comes to Workers’ Comp? Take a look at our downloadable Workers’ Compensation Claim Checklist to help keep you on track and claims clean or give us a a call at 855-208-5566!

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