state lists covered services, but reserves the right to deny claims. A claim could be refused for example, if appropriate/provided safety equipment was not being used at the time of injury (Valerius, Bayes, Newby, Blochowiak, 2014, 398). All parties involved have important roles for successful acquisition of reimbursement. To follow claim expectations, an employer is required to report injuries to the state Workers Compensation board and insurance within state assigned time frames. The employer (human resources) then directs the worker to a network physician for medical services. Other expectations are state specific. For instance, NY has a record retention requisite. Data for one calendar year (from point of injury), is kept in original form for a minimum of three years (Workers compensation board, 2016). Although an employer may voluntarily follow the case, the extent of mandatory involvement ends here. A physician treats, determines scope (if any) of disability, and monitors a progression back to work. The insurance is responsible for assigning claim numbers (used to ID claims) and defining case eligibility. The results will either be of liability’ or of contest’, to which the worker is ‘admission ‘notice informed. Claim checks covering medical expenses are sent directly to the provider. While, lost wage benefits are allocated to the employee without tax deduction; until criteria have been met and termination of compensation is appropriate (Valerius, Bayes, Newby, Blochowiak, 2014, 400). As billers, we need to recognize consistent reimbursement standards associated with Workers Compensation. First, a patient will not have out-of-pocket fees and should not be charged for a visit (Szymendera, 2016, 19). Also, private insurances are not billed for Workers Compensation related services. The claim will be denied because most payers do not restitute such circumstances. Unlike Medicaid, Workers Compensation claims (most states) are filed manually
state lists covered services, but reserves the right to deny claims. A claim could be refused for example, if appropriate/provided safety equipment was not being used at the time of injury (Valerius, Bayes, Newby, Blochowiak, 2014, 398). All parties involved have important roles for successful acquisition of reimbursement. To follow claim expectations, an employer is required to report injuries to the state Workers Compensation board and insurance within state assigned time frames. The employer (human resources) then directs the worker to a network physician for medical services. Other expectations are state specific. For instance, NY has a record retention requisite. Data for one calendar year (from point of injury), is kept in original form for a minimum of three years (Workers compensation board, 2016). Although an employer may voluntarily follow the case, the extent of mandatory involvement ends here. A physician treats, determines scope (if any) of disability, and monitors a progression back to work. The insurance is responsible for assigning claim numbers (used to ID claims) and defining case eligibility. The results will either be ‘admission of liability’ or ‘notice of contest’, to which the worker is informed. Claim checks covering medical expenses are sent directly to the provider. While, lost wage benefits are allocated to the employee without tax deduction; until criteria have been met and termination of compensation is appropriate (Valerius, Bayes, Newby, Blochowiak, 2014, 400). As billers, we need to recognize consistent reimbursement standards associated with Workers Compensation. First, a patient will not have out-of-pocket fees and should not be charged for a visit (Szymendera, 2016, 19). Also, private insurances are not billed for Workers Compensation related services. The claim will be denied because most payers do not restitute such circumstances. Unlike Medicaid, Workers Compensation claims (most states) are filed manually
1482322828_MAAT235_Final_Portfolio.docx