Workers’ Compensation Billing

March 24th, 2010

by Jackie Stack, AAB, CPC, CPC-I, CEMC, CFPC, CIMC, CPEDC, CCP-P

Workers compensation billing can be confusing at times. Knowing a few background guidelines and rules can help you along the way. Workers’ compensation provides coverage for wage replacement benefits, medical treatment, vocational rehabilitation and other benefits to workers who are injured at work or acquire an occupational disease. There are federal and state laws that require that employers maintain Workers’ compensation coverage to meet minimum standards.

Occasionally a patient will come into an office and see a provider for an illness or injury that is work-related; however, the patient fails to inform the provider that the illness or injury is work-related. If this happens, the patient’s primary payer then gets billed for the services or procedure. If the patient then requests that his/her workers’ compensation insurance be billed for the service and the primary payer has already paid the provider, the workers’ compensation insurance will need to be billed. If the workers’ compensation claim is denied, an appeal will need to be initiated. The reimbursement paid by the primary payer must be returned.

Sometimes a patient will present to the provider for a workers compensation injury and also wish to be seen for a reason unrelated to the employment injury. Providers must be cognizant of the need to keep both encounters separate, with separate encounter forms.

Keep in mind that HIPAA privacy rules must be followed, and illness or injuries unrelated to a workers’ compensation injury should never be billed to the employer.

Billing for workers’ compensation claims can differ from state to state, sometimes making it problematic. Knowing you state’s regulations, which are established by your state commission, will keep your practice in compliance. However, there is general nationwide billing information for workers’ compensation claims that does help keep billing somewhat uniform.

It’s important to utilize the correct forms when billing for workers compensation; these forms include the First Report of Injury Form and the CMS-1500 claim form. The First Report of Injury Form should be completed when the patient first seeks treatment for a work-related illness or injury, and the physician is responsible for completing this form. The physician’s billing department will also need to submit a CMS-1500 claim form along with the physician’s documentation to the workers’ compensation insurance for reimbursement. The date of injury always needs to be completed on the CMS-1500 and can often be overlooked by billing.

Workers’ compensation insurance will have no deductible or copayment, and all providers must accept the compensation payment as payment in full. Balance billing of patient is prohibited. The state compensation board or commission establishes a schedule of approved fees and can be found on individual state websites.

More information on workers compensation can be found at http://www.dol.gov/dol/topic/workcomp/.


Tags: ,

12 Responses to Workers’ Compensation Billing

  1. DENISE Says:

    I WORK FOR A COMPANY AND ABOUT 45% OF OUR BUSINESS IS WORKER COMP. WE ARE LOOKING FOR A CLASS OR SEMINAR ON WORKER COMPENSATION REGULATION IN THE STATE OF NEW JERSEY, OR THE REGULATIONS THEMSELVES IN WRITING. WE HAVE A REALLY HARD TIME COLLECTION FROM THE TPA’S AND NEED TO KNOW IF THERE IS ANYTHING THAT CAN BE DONE OR ARE WE DOING EVERYTHING WE CAN TO COLLECT OUR PAYMENTS..
    SO IF ANYONE KNOWS OF SOMETHING LET US KNOW….

  2. Peter Says:

    Thanks Denise for posting this. I also work for a company that handles a large volume of workers comp surgical and PT business. We are looking for a similar program. If anyone can recommend a good program, it would be greatly appreciated. Thank you.

  3. Linda A Says:

    I am working for a Labratory looking for classes how to bill work comp claim . Please advise

  4. Robin Says:

    I would like to know about Work Comp billing course in San Jose, Ca. or closest location. Specified for Orthopedics would be even better. Thank you

  5. Steve Lowery Says:

    I have been billing Workers Comp for over 15 years now and athough some laws varie from state to state the collections process and procedures are about the same. I can help!

  6. melody Says:

    i am trying to bill work comp for psychological services 50 min sessions i have tried 5 diffrent cpt codes none of them are correct HELP!!!

    melody
    california

  7. La Quenta Gross Says:

    Melody have you tried 90844 fo 45-50mins, hope that helps.

  8. La Quenta Gross Says:

    Melody have you tried 90844 for 45-50mins, hope that helps.

  9. Rob Says:

    There is a physician fee schedule (billing) class in Oakland on Nov. 15 and Dec. 13 in Los Angeles. The billing method for workers’ comp physician services changes on Jan. 1, 2014. A continuing education provider WorkCompCentral.com has medical billing and coding classes, live and online. The instructor Sue Honor is excellent; she worked for the California Division of Workers’ Compensation and knows the FAQs and most common mistakes medical billers make when submitting treatment bills for payment.

  10. Carolina Says:

    Can I bill workers comp claims as incident to provider? We are in TX, the provider is credentialed by his physical therapist don’t. Can the physical therapist see the patients and bill under the provider npi ?

  11. LISA Says:

    I would like to attend workers’ comp billing classes for the hospital facility side for the state of Ohio. Can you point me in the right direction of some traing classes for hospital workers comp billing?

  12. Julie Says:

    Can our doctor bill workers comp for a meeting with the workers comp adjustor?

Add a Comment

Attention: AAPC does not regularly monitor comments posted here. For customer service issues, contact us. In addition, we recommend posting your questions to the AAPC forums.

*