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Common Misconceptions of Worker’s Compensation and Patient Access Services

A common misconception among front line staff is that worker’s compensation provides full medical benefits for all medical services rendered to an injured worker. Many hospital and healthcare providers believe an injured employee covered under an employer sponsored Worker’s Compensation claim can see as many providers as needed to receive essential care. Though it is true according to the Mississippi Worker’s Compensation Commission “an injured worker is entitled to whatever reasonable and necessary medical services are required to treat the injury and achieve maximum cure. These include but are not limited to doctor and hospital services, nursing services, medication, physical therapy, crutches and any other apparatus or medical service which is necessary.” However, it is important to remember that:

  • Worker’s compensation benefits only cover one referral from the patient’s originating servicing provider to another servicing provider
  • All additional referrals must be approved by either the employer’s worker’s compensation insurance carrier or the Workers Compensation Commission.

Therefore, if not captured and tracked appropriately, these additional patient referrals have the potential to cause significant denials for noncovered services with no authorization. That is why it is imperative that we utilize effective and efficient scripting when registering or scheduling a patient for work related injuries. Best practice industry standards suggest that:

  • If an injured individual(s) arrives for services without an employer sponsored accident-related report or approved worker’s compensation claim form, the patient’s medical insurance is to be entered as Primary with the patient listed as the guarantor; this is true for both urgent and non-emergent scenarios
  • If an injured individual(s) arrives for services with an employer sponsored accident-related report or approved worker’s compensation claim form, this information is to be entered as Primary and the patient’s medical insurance as Secondary listing the “employer” as the guarantor

If you are concerned about potential reimbursement associated with worker’s compensation claims for services rendered at your hospital or healthcare servicing provider, you may want to revisit your front-end revenue cycle process and strategy. Here is a helpful link to CMS for additional information WCFacts2013.pdf (ms.gov) or you may contact Trilogy Revenue Cycle Solutions.

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