Back in the 1800s, states began passing acts offering certain rights to injured employees, evolving into what we now call Workers' Compensation. These laws are still issued on a state-by-state basis, meaning the exact rules and regulations vary, making the workers' comp billing process challenging from an operational perspective. Mix in a lot of paperwork and strict timelines, and these claims can become taxing for those concerned with revenue cycle management.
In workers' comp cases, you're dealing with a legal process alongside a medical service, essentially doubling the number of parties involved. This can make effective communication a challenge. In addition to the patient and primary provider, information needs to be communicated to the payer/network, the work comp case manager, and/or the employer. These communications must be timely and detailed because if the patient isn't working and is receiving some form of payment, they must prove that they're being seen by someone in order for benefits to continue, especially when it comes to outpatient cases. Every visit and every claim must be adjudicated by supportive documentation, including things such as schedules and clinical notes to show patient attendance, progress and medical necessity.
Fortunately, the overhead and administrative burden that come with a workers' compensation claim can be efficiently managed with the help of modern technological attributes. Through advances such as electronic filing and interoperability between workers' compensation networks and states, data can be easily captured to benefit your revenue cycle in the following ways:
- Ensure Necessary Care and Accurate Claim Submission: Data sharing and interoperability enable multiple parties – from clinical review nurses and case managers to payers – to access vital information at the same time. In the past, it could be days or even weeks between data uploads and reports. Now data can be shared immediately, helping injured workers receive the procedures they need in order to return to productive status, and helping you document and report the care given.
- Improve Claim Submission Speed and Compliance: Manually processing claims is slow and time consuming. Eliminating paper claims and filing electronically reduces the time it takes to submit and process them, making it easier to comply with timelines set out by payers, while making it less burdensome for your center.
- Reduce Denials and Boost Revenue Quicker: Technology creates a critical connection between the processing, data verification and implementation required by the payer. Software platforms can not only reduce human errors and oversights, leading to less denials and maximum reimbursement, but they can also automate steps throughout the workers' compensation management process, helping move the claims forward and lowering accounts receivable days.
Bring your outpatient workers' compensation claims process into the modern age, and overall, you'll reduce your administrative burden and enhance your operational efficiency. Plus, these claims can be some of the highest paying from a revenue perspective. So the overhead and excess data is definitely worth the payout – especially if it's made more efficient with today's resources.