Workers' Compensation Billing & Collection

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Medical Billing and Collection services (Workers’ Compensation)

What is Workers’ Compensation? When an employee is hurt on the job or gets sick from a work-related cause. Workers’ compensation is also known as workman’s comp, workman’s compensation, and workers’ comp. These terms all mean the same thing and help protect workers from potentially devastating costs of work-related injuries by providing medical benefits, as well as wage replacement due to the injury.

Every State has different set of laws pertaining to Workers’ Compensation. These laws often change which makes the system very complex, due to these complexities often medical providers feel frustrated and discouraged; as a result, many providers refuse to treat employees injured in the course of employment.

How are we different? Most medical billing companies only provide some of the elements required for a complete Workers’Compensation billing solution. We are a team of medical billers and collectors with specific experience in Workers' Compensation claims, providing you with complete billing and collections services for your medical practice or facility.  We excel in coding and proper submission of medical bills and invoices for your claims in compliance with the Labor Code, and our collections team aggressively collects, negotiates and resolves unpaid Workers' Comp claims.

No matter what the size or whether you have been in practice for years or are just starting up, we are confident that our experience and expertise will help streamline your medical billing process, saving you time and money. We specialize in optimizing your workers’ compensation billing and increasing your collections. Leave all the problems associated with getting paid to us, so you can focus on your most important priority. Patient Care!

How do we handle Medical Billing?

  • We review your patient intake procedures, CPT and diagnostic coding, and medical reporting, to ensure that your Workers’ Comp services are properly coded and that your reports are adequate to ensure payment at the maximum amount, with no delays or denials, in accordance with Labor Code 4600.

  • We enter your treatment charges in our state of the art practice management system and bill them electronically or paper as per required.

  • We attach all required documents (PR2, P&S, Authorizations, Prescriptions etc.) to a complete HCFA/UB04 billing statement.

  • We serve your bills with attached, dated Proofs of Service to monitor each of your payments and denials for timeliness. Penalties and Interest assessed for late pay per LC 4603.2(b).

  • As a part of complete medical billing process, we take timely follow up on all bills submitted within 30 days of the submission to make sure the bill is reached insurance and in line of payment.

  • We stringently do second bill reviews on partial paid claims and work on denials to make sure our provider is paid what actually is owed to them.

  • We litigate the matter and aggressively try to collect on the provider dues.

  • We also represent our providers in hearings at almost all the venues in southern California.

  • We provide you with a wide variety of statistical reports, aging, case status and all Practice Management Reports.

À-La-Carte Services

 

We provide some of our services on ‘a la carte’ basis as well.

Clerical Services:

  1. Insurance Verification

  2. Request for Authorization (preparing and follow up)  

  3. Charge Entry, Insurance Claim Submission

  4. Payment Posting

  5. Second Bill Reviews, Appeal Submission 

  6. Edex Filing, Lien/DOR Filing

  7. Calendar Management, Exhibits Listing

Collection Services:

  1. Our collections team responds to claim denials and objections with demands for payment in full: U/R denials, MPN issues, reductions per OMFS are addressed with defenses from case law and/or the Labor Code.

  2. We follow up on all unpaid bills over 45 days old with demand for payment along with Penalties and Interest per LC 4603.2(b).

  3. We file and serve liens with its bills and reports on all claims where proper payment is not timely received.

  4. We aggressively negotiate maximum reimbursement for your liens.  Professional WCAB litigation and Appeals.

  5. We represent our clients for Lien Conference and Lien Trials.

Official Medical Fee Schedule Review (Bill Review)

The Official Medical Fee Schedule (OMFS) is promulgated by the DWC administrative director under Labor Code section 5307.1 and can be found in sections 9789.10 et seq. of Title 8, California Code of Regulations. It is used for payment of medical services required to treat work related injuries and illnesses.

Often insurance payers do not follow the guidelines provided by the DWC to review and pay medical provider’s claims for injured worker’s treatment. Insurance companies down code /partially pay / or offer zero payment erroneously, citing vague reasons even after multiple attempts of second bill review and independent bill review. In most cases, insurance companies do not reimburse providers the right amount that they are entitled to, which results in providers litigating the matter at the Workers’ Compensation Appeals Board.  In court defense attorneys representing insurance companies state that they “paid per fee schedule” at that point of time it becomes very important for a lien claimant to produce a certified bill review. Having a certified bill review guarantees a greater outcome when faced against defense’s argument of ‘being paid appropriately’. A bill review provides an extra shield of protection for providers while they guard their rights to be reimbursed according Official Medical Fee Schedule.

 

How we can help?

We provide Official Medical Fee Schedule Review (Bill Review) as a service to Workers’ Compensation treating providers and are focused on helping Lien Claimants settle their liens and be prepared for Trial with the proper evidentiary Certified Bill Review.  We are able to provide a flat fee per bill review at a reduced rate when working on a bulk amount of bills.  We can do all of your hearing calendar set for Lien Conferences and/or Lien Trials in an expedited manner and at fraction of cost from our competitors.

Our team is located in California and India, we have a trained team in India able to quickly and efficiently create multiple bill reviews that are then reviewed, approved, and certified by our Certified Bill Review Experts.  At a Lien Trial, our Bill Review Expert(s) can be present to testify to the accuracy of its bill review.

Why is obtaining the OMFS from a software insufficient?  Simple, software and/or non-certified bill reviewer cannot testify to the authenticity and validity of the value of their Bill Review.  A few important reasons to hire us:

  1. Importance of bill review: a Certified Bill Review needs to be part of the Exhibits at the Lien Conference so that the Judge accepts it at the Lien Trial without objection.  Many times a Judge will disallow a bill review at a Lien Trial if it was not part of the original Exhibits or served within 20 days of Trial.

  2. Bill Review is essential to settle cases at the Lien Conference as the defense shows up with a bill review and many times a bill review expert.  There is a much higher success rate of settlements at Lien Conference with a Certified Bill Review which ultimately avoids Lien Trials in the future and the costs associated with it.  We have consistently seen a higher settlement amount when a Certified Bill Review is prepared.  Simply having a software printout or an Excel from an internal team with a Bill Review is insufficient as they are not admissible evidence at Trial.