Workers’ Compensation – Components for Success

Are you aware that in a typical chiropractic practice, many doctors feel a bit anxious about accepting workers’ compensation cases? Being prepared and knowing what to expect can help alleviate a lot of that anxiety and make the decision to accept these types of cases or not an educated one.

Much of the trepidation related to treating patients with work-related injuries is simply the result of being unfamiliar with the procedures that must be followed when filing a workers’ compensation claim.

Let’s start with the basics. What is Workers’ Compensation?

Workers’ compensation refers to a specific type of case and claim that covers a patient who has been injured on the job. Keep in mind that your state has precise rules and regulations that you must follow for these cases.

There are four main components that you must pay close attention to in a workers’ compensation case:

Early Identification

• Be certain to have protocols in place to assist in detecting whether a patient’s injury is work related before treatment begins. Workers’ compensation claims most often require prior authorization for treatment, and many states are very stringent with their specific reporting time frame. Asking specifically if an injury is work related before any treatment is administered is key to avoiding the headache of trying to gain retroactive approval later.
• Make sure you have been in touch with the employer to confirm that a claim is opened. Some employers require that employees see a company doctor, and there may be no authorization to see your practice.

Documentation

• The specific forms and reports that are required for workers’ compensation claims will vary from one state to the next. Be certain, first and foremost, that you are familiar with the guidelines for your state. The governing agency for your state is easily found online.
• It is imperative that you take the time to learn how to properly document your patient’s care. Proper documentation should read like a story that can be easily followed from beginning to end.
• It goes without saying that you must specifically document the treatment of your patient. But you should also detail all communication and pertinent information between your office and the adjuster, attorneys, utilization review department, and primary treating physician.

Appropriate Coding

• Some medical fee schedules only permit chiropractors to bill specific codes. Some of these may be codes that are no longer in commercial carrier circulation. Take time to familiarize yourself with these.
• Also, keep in mind that the only services allowable for reimbursement will be those administered to the region of injury identified for the claim.

Billing

• Workers’ compensation cases have specific guidelines for billing. This can vary between payer and state. Again, it is imperative that you verify these guidelines for each individual patient and case.
• Confirm with the employer that they are not self-insured. Some companies, especially larger ones, choose to have a very high deductible with workers’ compensation claims. Therefore, they pay minimal claims themselves, to avoid using insurance. Be sure you know who is controlling the claim.
• Most states have a specific fee schedule. It is very unlikely that you will ever receive 100% reimbursement for your submitted charges.
• If you accept a valid workers’ compensation claim, you must adhere to the fee schedule allowed and may not bill unpaid charges to the patient.
• Familiarize yourself with the differences between state and federal workers’ compensation. They are not the same and cannot be treated as such. It cannot be stated enough that you must verify and become familiar with the coverage and allowances of each.

Finally, be diligent in your quest to become more familiar with the precise details of workers’ compensation protocols.  Executed properly, workers’ compensation cases can be a great boost to your practice.

Dr. Colleen Auchenbach graduated with a Doctor of Chiropractic from Cleveland University Kansas City in December of 1998 and enjoyed practicing for over 20 years. Her interest in Medical Compliance began when she earned the 100-hour Insurance Consultant/Peer Review certification from Logan University in 2015. She has been a certified Medical Compliance Specialist-Physician since 2016 and a Certified Professional Medical Auditor since 2022. Dr. Auchenbach joined the excellent team at KMC University as a Specialist in 2020, and as a part of this dedicated team is determined to bring you accurate, current, and reliable information. You may reach her by email through info@kmcuniversity or by calling (855) 832-6562.