Top 5 Worker’s Compensation Claim Tips

patient collections in physical therapy

With all of the components involved in worker’s compensation claims – case managers, adjusters, authorizations, and global fees – it can be tricky for physical therapy practices to manage.  Here are your top 5 tips to help get your Worker’s Compensation claims paid faster.

  1. You should always verify the Workers’ Compensation eligibility of the patient before any treatment is rendered. You need to verify the name of the adjuster, claim number, date of injury, and the body part that relates to the claim. Many carriers require that the “approved diagnosis” is included on your claims. Make sure the therapist knows what the approved diagnosis is.
  2. Do not accept a verbal authorization from an adjuster; always try to get a hard copy. If your claims are denied as not authorized, it is very difficult to appeal claims with only a verbal authorization.
  3. Authorizations often are given with visit and date restrictions. The authorization might be good for 12 visits, but if the visits fall outside of the date range approved, your claims may get denied. It’s important to track authorized visits and to contact the adjuster before an authorization expires if your patient needs more visits.
  4. While you have the adjuster on the phone to verify benefits and to obtain an authorization, it’s also a good idea to ask him/her if they are a part of a network (ex. Align Network, or Medrisk). If they say yes, this will impact where your claims are sent. A common mistake that will delay your claims being paid is sending the claims directly the insurance carrier, when they should be sent to the network for processing.
  5. If your work comp claims require chart notes to be attached, be proactive and send copies of your notes with your claims the first time.  If you claim is pended for medical records, the payment for that claim can be delayed for several weeks.

Combining these tips with our Therapy Engine EMR will make navigating the Worker’s Compensation process easy.

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