If your independent clinic is handling workers’ compensation claims you need to understand the ins and outs of getting paid.Work Comp image

On the administrative side, keeping a clinic workflow that segregates comp and non-comp is standard. The patient plays a key role in providing the proper documentation on the date of injury, getting a claim filed, and making sure the insurance adjuster is following through on their claim. Educating patients on the different requirements for a work comp visit is big help. Independent clinics should  instruct their patients to bring the following information to each appointment:

  • The name and HR contact information the patients employer
  • Workers comp insurance company name as well as the name, address, phone number and fax number of the patient’s insurance claims adjuster
  • Patient’s insurance claim number
  • Information on medical history, other providers treating the patient and list of medications
  • Patients should be prepared to give an accurate description of how the injury occurred and any body part that was affected
  • Status of symptoms and whether they are improving, worsening or staying the same
Work Comp Workflow

State of Minnesota Department of Labor graphic

The clinic will need to provide a report of work ability and provide all dictation, reports and information to the workers comp adjuster. Patients must also leave their visit with an understanding of their responsibilities to receive work comp coverage. Patients are responsible for maintaining communication with their adjuster for any address or phone changes. The adjustment must also be informed when the patient returns to work, if work hours or pay change, and if you are placed off work due to the injury. Patients should take notes of phone conversations with their adjuster and employer to avoid miscommunication and unmet requirements. There is assistance for employees having difficulty with their workers comp adjuster or employer through the Minnesota Department of Labor and Industry’s hotline at 1-800-342-5354.

Workers’ compensation continues to lag behind other health care payments with higher A/R and denials than other industry areas. This is a result of administrative barriers and slow integration of e-billing. Having your internal workflow based on best practices can reduce the overall challenges encountered when billing and the number of accounts having excessive time from service to claim resolution.
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