Billing Workers Comp at the Correct Fee Schedule
Doctors often bill more than they expect to get paid by an insurance company on a medical insurance claim.
There are many things that determine what they charge and what they are paid.
How much the insurance company allows for a procedure code and whether or not the provider participates with the insurance company are just two examples.
But when you bill claims out for a workers comp injury, you are supposed to bill out the charges at the workers comp fee schedule.
A lot of providers just use their standard fees but this can get you in trouble.
Insurance carriers can (and do) file a complaint against you with the state insurance commissioner for overcharging even if you write off the difference and never bill the patient.
How do you know what the fees are in your area and where can you get a copy of the workers comp fee schedule? A logical question after finding out you need to bill at their fee schedule amounts.
Well, you can't always get it from your workers comp board.
Many states have the fee schedules available online, but many do not.
The states that do not offer online schedules usually point you in the direction of Ingenix where you can purchase a fee schedule.
The problem with that is that most of us only require a few of the codes and don't need all the rest of them.
Who wants to purchase an expensive book for a bunch of data you don't need.
Especially after learning that Ingenix is owned by United Health Care and their practice with out of network payments recently exposed in the news.
So what is the answer? Well, if you have already been billing workers comp, then you just need to look at some of the eobs and find the payments allowed for the codes you use.
Begin using those amounts asap.
If you have a code to bill and do not know the allowed amount, you can bill it out at your regular fee schedule, but make a note when it is paid so next time you have to bill that code, you know what was paid.
Bottom line is that if you are billing out your regular fee schedule on your workers comp claims, you need to find a way to switch over to the comp fees immediately.
You don't want to be answering a complaint from the insurance commissioner if you can avoid it.
Copyright 2009 - Michele Redmond & Alice Scott - Solutions Medical Billing Inc
There are many things that determine what they charge and what they are paid.
How much the insurance company allows for a procedure code and whether or not the provider participates with the insurance company are just two examples.
But when you bill claims out for a workers comp injury, you are supposed to bill out the charges at the workers comp fee schedule.
A lot of providers just use their standard fees but this can get you in trouble.
Insurance carriers can (and do) file a complaint against you with the state insurance commissioner for overcharging even if you write off the difference and never bill the patient.
How do you know what the fees are in your area and where can you get a copy of the workers comp fee schedule? A logical question after finding out you need to bill at their fee schedule amounts.
Well, you can't always get it from your workers comp board.
Many states have the fee schedules available online, but many do not.
The states that do not offer online schedules usually point you in the direction of Ingenix where you can purchase a fee schedule.
The problem with that is that most of us only require a few of the codes and don't need all the rest of them.
Who wants to purchase an expensive book for a bunch of data you don't need.
Especially after learning that Ingenix is owned by United Health Care and their practice with out of network payments recently exposed in the news.
So what is the answer? Well, if you have already been billing workers comp, then you just need to look at some of the eobs and find the payments allowed for the codes you use.
Begin using those amounts asap.
If you have a code to bill and do not know the allowed amount, you can bill it out at your regular fee schedule, but make a note when it is paid so next time you have to bill that code, you know what was paid.
Bottom line is that if you are billing out your regular fee schedule on your workers comp claims, you need to find a way to switch over to the comp fees immediately.
You don't want to be answering a complaint from the insurance commissioner if you can avoid it.
Copyright 2009 - Michele Redmond & Alice Scott - Solutions Medical Billing Inc
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