12 Jul Workers’ Compensation and PIP Claims Mistakes to Avoid
Medical practices have a variety of requirements to adhere to in order to grow and maintain a thriving practice. Practitioners will see many patients with multiple conditions and insurance carriers.
Some patients will be in the office only once per year for a routine physical, and they may pay with cash out of pocket, or they may have adequate insurance to cover the entire balance. Other patients may require a series of regular visits and may be using a combination of payment methods. This process can become confusing and is even prone to errors if a medical practice is not familiar with the requirements.
When a patient has been involved in an accident or injury at work or otherwise, they may be under a specific treatment payment plan through workers’ compensation or insurance carrier PIP coverage. This can lead to confusion if the injury information was not collected at the first visit.
These initial and subsequent claims may be denied by the insurance company if they are not properly filed with the appropriate agencies. There are a few ways that a medical practice can avoid workers’ compensation and PIP claim errors that could result in nonpayment of claims.
Upon the initial visit, medical personnel should verify the reason for the office visit and determine if there was an accident or injury that occurred on the job. If the visit is a result of either of these instances, the patient and physician should conduct a brief interview to thoroughly understand the complete situation.
This discovery process will include details such as when, where and how the accident or injury occurred, as well as any other witnesses that were present or made aware after the fact and how long it took the patient to receive medical treatment. If an insurance claim or accident report has already been filed, the medical practice should gather the information and keep everything on file for when billing begins.
Consult an Expert
If an attorney is representing the patient, the medical practice should be in contact with the legal representation throughout the duration of the case. This contact may include but is not limited to providing copies of treatment plans, physical therapy, status updates, and a running total of invoices due and overall cost of medical treatments.
There should also be an expert in the medical practice that has experience processing workers’ compensation and PIP claims and can help the physicians and medical billing associate with processing these claims. Having a medical billing company with expertise in PIP and Work Comp claims will help dramatically with success in revenue.
Keep Accurate Records
The single biggest mistakes that medical practices make when processing workers’ compensation and PIP claims is not organized records. The billing system must be immaculate for a few reasons.
First, the claims are going to be included in an audit – either internal or external – and will be scrutinized for accuracy. Claims adjusters will seek out even minor errors and typographically mistakes as a valid reason to not pay workers’ compensation and PIP claims.
The second reason to keep immaculate records for these specialty claims is that they are likely to be delayed in processing. If a medical billing specialist does not keep close records, they will not send reminders or duplicate invoices to the paying agent.
If payments are not received in a timely manner, the claim could expire and the medical practice will not receive payments for services rendered. Finally, accurate records must be kept to ensure the patient and their legal representation if applicable, can have provide the total amount paid out of pocket, which should be refunded as part of the insurance claim settlement.