Effective
Registration
of
Workers’
Compensation
and
Motor
Vehicle
Accident
Patients
MAHAM Webinar January 25, 2013
Patrick McDonough, Director of Business Development ProMedical, LLC
Who
am
I
and
Why
am
I
Here?
Introduction
Goals
for
the
Presentation
• Give a basic overview of Workers’
Compensation and Motor Vehicle regulations
• Identify real‐world issues that impact effective registration and billing of Workers’
Compensation and Motor Vehicle claims
• Provide you with some practical tips for procedures you can implement in Patient Access that helps make the reimbursement issues go away
Introduction
One final goal is that I don’t want to be the guy that puts every single
word he says on the slides for everybody to try to either read on the
screen or in their handouts, but because there are so many words the
type ends up microscopic and by the time you finish reading the slide,
it’s already time to move onto the next one and you have no time to
absorb any of the information that has been thrown at you. First, those
presentations tend to be insanely boring. Second, when speakers do
that, no real learning takes place because people don’t have to think.
And third, the handouts cease to be a good reference for future use
because there’s simply too much information to weed through.
Instead, my slides and handouts will be a good outline and summary of
the subject matter I’m covering, but I will leave it up to all of you to
write down the parts that you deem important enough for you to want
Summary of Regulations
MGL Chapter 152: Workers’
Compensation Act
• Law that guarantees certain services and
benefits to workers injured on the job
114.3 CMR 40.00 and 114.1 CMR 41.00
• Establish rates of payment for services for
Summary of Regulations
MGL Chapter 90 Section 34M: Motor Vehicles
and Aircraft: Personal Injury Protection
• Confusingly written law which establishes that MA is a “No‐Fault” state and that PIP insurance is the primary payer up to $2,000 (max of $8,000 per accident) with coordination of benefits after $2,000 per person
• (Later clarifications much more clear: 2008 clarification:
http://www.mass.gov/ocabr/government/oca‐
agencies/doi‐lp/2008‐12‐clarification‐of‐ coordination‐of.html
Summary of Regulations
WC Claims:
• Inpatient claims paid at PAF rate
• Outpatient and Amb Surg claims
paid according to fee schedule
• Insurers can demand medical
Summary of Regulations
MVA Claims:
• Paid according to usual and customary charges
• First $2,000 paid by PIP (to a maximum of $8,000 per accident including expenses and lost wages)
• After that, bills go to patient’s health carrier. (If the patient has no health insurance, has
Medicare or Medicaid health insurance, or other ERISA plans, PIP pays up to $8,000)
• If a patient has MedPay benefits, health insurer can demand those benefits paid before health.
Billing Issues
Reasons WC and MVA Claims Don’t Get
Paid:
1. Patients
2. Employers 3. Insurers
Billing Issues
Things Patients Say
"I don't know my employer's address"
"I don't know the proper contact at my employer" "I'll get that information for you"
"I don't know my insurance company"
"I wasn't driving"
"No, I <hiccup> wasn't drinking before the accident"
Billing Issues
How many of you work in a building that
Billing Issues
Common Thread: All involve some type
of missing information
Solution: Gather as much information
Gathering Information
Make sure EVERYTHING is documented! Basic Patient Demographic Information:
• Name
• Address
• Phone Number
• Cell phone number
• DOB
• SSN
• Health Insurance Information
Gathering Information
Accident Information: • Date of injury
• Description of injury
• Date of initial treatment Authorizations:
• Authorization to release information • Assignment of Benefits
Attorneys:
• Obtain name and contact information of any attorneys involved
Gathering Information
Workers’ Comp Claims:
• Employer Name
• Employer Address
• Contact at Employer
• Employer’s Insurer
Gathering Information
MVA Claims:
• Vehicle Owner’s Insurance Company,
Address, and Policy Number
Best Practice Information Gathering
Let’s REALLY cover ourselves:
• “Tell me about the accident….“
• “How exactly were you injured?”
• “Were there any witnesses to the accident? ”
• “Was the injury reported to anybody?” If yes, to
whom?
• (If MVA) “Do you have contact information for the
other driver?”
• (If WC) “Do you know your company’s Workers’
Compensation insurance information? If not, do you
know where it’s posted?”
• The Point: Don’t automatically accept answers that
Best Practice Information Gathering
Bonus Question:
Is there something we can do to
make it more likely that patients
will give us the information we
Best Practice Information Gathering
Bonus Answer:
Pre‐registration! Don’t forget to
include Workers’ Compensation
and Motor Vehicle patients when
Giving Out Information
Information is a two‐way street WC patients should be told:
• Employer must report injury to their
insurance company
• First report of injury (Form 101) must be
filled out when an employee cannot earn full
wages for 5 business days; report must be
completed within 7 days of that 5th day of
Giving Out Information
WC patients should be told (cont’d):
• Details of your collection policy
MVA patients should be told:
• Enough about process to know why
health and auto insurers are both
involved
Resources MGL Chapter 90: http://www.malegislature.gov/Laws/GeneralLaws/PartI/TitleXIV/ Chapter90 MGL Chapter 152: http://www.malegislature.gov/Laws/GeneralLaws/PartI/TitleXXI/ Chapter152 WC Fee Schedules: http://www.mass.gov/eohhs/gov/laws‐regs/hcf/dhcfp‐ regulations.html#114_3_40 http://www.mass.gov/eohhs/gov/laws‐regs/hcf/dhcfp‐ regulations.html#114_1_41
WC Form 101 (Report of Injury):
http://www.mass.gov/lwd/workers‐compensation/wc‐
Questions?
Thank you!
Patrick McDonough
patrick@promedLLC.com
