Workers’ compensation claims are among the most litigious and challenging medical claims to manage. Legislation and regulations impacting workers’ comp claims frequently change, requiring a higher level of administrative oversight to keep up with and appropriately submit. As healthcare costs rise, investing more in workers’ comp claim management is another cost many organizations simply do not have the bandwidth to prioritize. Fortunately, specialized workers’ comp revenue cycle management technology and workers’ comp RCM experts exist who can help improve your practice’s cash flow and reduce administrative headaches.
A Refresher: What is Workers’ Comp RCM?
Workers’ comp claims originate when an employee is on the job working and gets hurt and does not get the support they need from their employer. For example, a warehouse employee may injure their back when lifting a heavy box. When they inform their employer, they may receive pain medication and some time off work from their employer’s industrial clinic. If they do not heal or get the care they want from their employer’s healthcare provider, they can hire an attorney to take the claim they originally filed with their employer. That attorney begins scheduling the employee with other medical providers (like your ambulatory practice, for example) to receive the care they need. At that point, a legal case is filed with the Department of Workers’ Compensation (whether an employer authorizes the healthcare services or admits the injury occurred on the job or not).
When your ambulatory practice cares for an injured worker during a Workers’ comp case, your treatment reporting (patient history, subject complaints, etc.) is part of that legal case and comes with specialized reporting requirements. The attorney and patient are trying to establish that they were hurt on the job, that they are entitled to treatment, and that you confirm that the treatment is needed to heal.
A workers’ compensation revenue cycle management expert (whether it is outsourced or in-house) represents your practice when you care for injured workers like the one in the example above. If an insurance company denies your patient’s injury or your services, a workers’ compensation RCM expert steps in and bills the insurance company for the services and works with their attorneys and adjusters to negotiate reimbursement.
Why Investing in Tech-Powered Workers’ Comp RCM Expertise Helps
All healthcare practices want to be paid more, faster, and want to handle billing in a more efficient way so they can focus on what they do best, patient care. Working with a workers’ comp RCM expert and/or investing in workers’ comp-specific tech can illuminate why insurance companies are short paying your practice or denying your services. These are a few of the primary beneficial reasons to invest in workers’ comp RCM expertise:
It Keeps Your Practice Compliant
Workers’ comp regulations change all the time and impact the way workers’ comp-related medical bills are processed. Working with a workers’ comp claim management specialist can prevent you from allocating internal staff to keep up with changing legislation and risking fines, legal action, and impacting your practice’s reputation.
It Helps you Defend your Practice
If your practice has been handling this internally or outsourcing, you may be finding that you are not seeing the results you want anymore. We notice that escalating legal changes and advancements in technology make it easier for insurance companies to aggregate data to build over-treatment and overbilling cases against doctors. In most cases, medical practices do not have the same resources insurance companies do. However, workers’ compensation RCM experts have data and expertise to help medical practices like yours compete with insurance companies in a court of law.
It Reduces Issues with Claims Denials and the Workload to Manage Them
Denials are extremely common in the workers’ comp-related medical billing world. If your practice does not have robust workers’ comp claim knowledge or ample bandwidth to appeal claims, it is likely you are leaving money on the table. A group that specializes in this specific billing process and can aggregate denial trends with data and technology can quickly and easily determine why your claim is being denied and handle the administrative burden of filing a lien with the state and a Declaration of Readiness to Proceed with the Department of Worker’s comp declaring that an intervention is needed. They will also handle presenting medical reports during legal cases related to your workers’ comp claims to prove the treatment provided was medically necessary and your practice is entitled to payment.
It Improves Cash Flow
If you are like many of our partners, you see a high volume of patients and do a high volume of treatments for injured workers. With high denial rates, this means you are building up a sizable workers’ comp accounts receivable tally. Without dedicated efforts to pursue these claims, your practice will be paid less and slower. A specialized workers’ compensation expert—especially one with access to worker’s comp claim data—can help you get paid more, faster for the treatment you provide worker’s comp patients.
It Saves you Time
As we have mentioned earlier in this article, workers’ comp claim management is the most time-consuming branch of medical billing. Maximizing collections requires a lot of follow up, resubmissions, and presence at legal proceedings. Working with a worker’s comp RCM expert can apply economies of scale and knowledge across many practices to help collect more, faster, completely removing the administrative burden of following up with Workers’ comp claims from your staff.
It Gives you Insights to Improve
Data-driven workers’ compensation RCM companies have aggregate information from the bills they send insurance companies, the denials, and short pays that insurance companies send back, and the communications back and forth with the insurance companies. They can aggregate this data to spotlight trends in attorney and insurance companies’ behavior and leverage these insights to help medical providers like you maximize revenue. For example, they may flag that your practice is billing too high above the medical fee schedule for a higher reimbursement percentage.
The Bottom Line: Worker’s Comp Billing is Getting Even More Complex, Dedicated, Data-Driven Worker’s Comp RCM Can Help
Worker’s comp legislation moves fast, and the technology at attorney and insurance companies’ fingertips is moving even faster. Working with a specialized expert that lives and breathes worker’s comp claims management every day can help you keep up with these changes, drive more revenue to your practice, and alleviate administrative burden. For 30 years, Resolv (formerly Innovative Medical Management) Workers’ compensation RCM services have helped practices like yours improve revenue and save time and costs.
Despite legislative changes and technology advances, Resolv remains effective at helping medical practices collect more of their workers’ comp claims through their dedicated team of experts and their data and technology—Conexem and CompData. These technologies are unparalleled in the industry and make it seamless to navigate medical-legal claims and speed up workers’ comp claims resolution. Most tools help keep you compliant with normal claims, but these technologies help specifically with issues pertinent to workers’ comp claims. Learn more about how they can benefit your practice here.
About the Author
Bassel Salloum, Executive Vice President, Resolv Healthcare / Innovative Medical Management
As the EVP of Resolv Healthcare / Innovative Medical Management, Bassel brings 30 years of experience in the Complex claims Revenue Cycle Management space. Bassel has dedicated his life to developing systems and strategies to educate medical providers with the practical application of certain processes that would ensure they received maximum reimbursement for their claims within the injury-based medicine segment. Bassel has developed expertise in California workers Compensation and Personal Injury billing, collections, legal representation, and complete Revenue Cycle Management for medical providers of all specialties including hospitals and outpatient surgery centers. His expertise in the industry led him to develop medical practice management software (Conexem Software) that is specifically designed to manage injury-based cases that is now used by more than 200 medical providers in California.