If the case is settled it becomes very difficult to collect after the fact. - Tim Tobin Medorizon Inc.
Chicago, IL (PRWEB) August 19, 2014
Medorizon helps medical practices and Ambulatory Surgical Centers (ASC) increase insurance and Personal Injury attorney payments with accurate and prudent billing techniques. First, there must be a clear understanding of the requirements for billing and documentation for the services provided. Workers compensation requires that all employers have a current policy in the event a worker becomes injured. It is the responsibility of the employer to supply the injured employee with all workers compensation policy numbers and correct remit to address so the medical provider can submit a clean and compliant claim. From there, it is the responsibility of the medical provider to perform a complete medical evaluation and clearly document all issues pertaining to the injury and how the injury is clearly and undeniably related to a workplace incident. Without this medical documentation the work comp insurers will deny and request the patient to submit to commercial insurance.
In both workers comp and personal injury medical claims it is very important to get authorization from the insurance company’s case manager and attorney. Typically, the insurance company will have a group of adjusters who monitor the patient progress and authorize required treatments. It is the responsibility of the treating physician, surgeon or surgery center to supply the case manager with clinical details of care and deliver a treatment plan geared toward recovery and getting the patient back to work. Furthermore, in personal injury and disputed work comp, the documentation and relationship is with the Personal Injury attorney who litigates the injury with the work comp carrier or within the court system. In dealing with attorneys, the billing office must be diligent and persistent. According to Tim Tobin, CEO of Medorizon, "The accounts receivable rep needs to have a scheduled call pattern set up seeking the status of the case. Many attorneys become annoyed at our persistent calls, but if the case is settled it becomes very difficult to collect after the fact." The claims processor needs to have a clear understanding for documentation, billing requirements and proper follow up to receive full reimbursement. If not, the insurance company may pay at a reduced rate in the hopes no follow up appeals will be initiated by the medical provider.
In most states payment rates are clearly published by CPT code for every approved service. If a service is not part of a payable fee schedule we suggest the medical provider does not perform the service. When payment is made it is the responsibility of the billing office to monitor reimbursement and make sure it reflects the accurate fee schedule. Many times the work comp carrier will pay below the fee schedule which needs to be appealed with proper documentation. Medorizon's office produces an appeal letter along with published copy of state fee schedule which results in additional payments. Dealing with litigated work comp cases the medical provider sends a notarized physician lien via registered mail. Without a notarized lien the medical provider does not have a legal document to insure payment.
If your practice needs expert advice or services, Medorizon has experience with both professional and facility billing. For many medical practices providing quality services to patients is easy—processing claims and getting reimbursement is the tedious part. Medorizon has grown to a 60-employee organization. Their staff manages the billing and collection process for hundreds of providers throughout the United States. Act now and take advantage of the offer to better acquaint your practice with the initial changes in moving forward to ICD-10.