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How to Bill Workers Compensation Claims
by Steven Guptha
Worker's Compensation
1. Workers Compensation laws are designed to ensure that employees who are injured or disabled on the job are provided with wage replacement and medical and rehabilitation benefits.
2. The intent of most workers compensation acts is to establish a system under which a worker no longer has to prove negligence on the part of the employer. Workers compensation act to compensate a worker for any injury suffered on the job, regardless of fault.
3. State compensation acts do not cover all employees or employers.
Federal Worker's Compensation Programs
1. Until 1908, workers injured on the job simply lost their jobs. Employees bore the full responsibility for on-the-job safety, and employers expressed little if any concern for the health or well-being of their workforce.
2. Federal Employees Compensation Act [FECA] provides benefits for work related injuries to all federal employees.
3. Occupational Safety and Health Administration Act [OSHA] protect the employees from injuries resulting from occupational hazards. The act established the federal occupational safety and health administration and also allowed the states to create an OSHA plan. Once the federal government approves the plan, the state assumes responsibility for carrying out OSHA policies.
To qualify for workers compensation benefits, the employee must:
1. Be injured while working within the scope of the employment agreement or job description.
2. Be injured while performing a service required by the employer.
3. Develop a disorder that can be directly linked to employment like asbestosis, mercury poisoning, or black lung diseases.
Compensation for permanent disability depends on the following:
1. Severity of the injury.
2. Amount of permanent loss of function.
3. Age of the employee.
4. Occupation before the injury.
5. Rehabilitation potential.
Block 1: Check the FECA box for all work-related injury claims.Block 1a: first claim: Enter the patients social security number. Subsequent claims: Enter the insurance carriers assigned claim number or the patients social security number.Block 2: Enter the patients name as directed.Block 3: Enter the patients birth date[MM/DD/YYYY] and check the appropriate box for gender.Block 4: Leave blank.Block 5: Enter the patients home address and phone number.Block 6: Check other.
Block 7: Enter employers address and phone number. If known.Block 8: Check employed.Block 9-9d: Leave blankBlock 10-10c: Check yes in block 10a. check 10b and 10c as appropriate.Block 10d: Leave blank.Block 11-11a: Leave blank.Block 11b: Enter employers name.Block 11c: Enter the workers compensation insurance carrier.Block 11d: Leave blank.Block 12: Leave blank. The patients signature is not required for workers compensation claims.Block 13: Leave blank.Block 14: Enter the date the symptoms started or the injury occurred.Block 15: Enter the date, if available or applicable.Block 16: Enter the dates as directed.Block 17: Enter the name and title of any referring health care provider, if applicable.Block17a: Leave blank or enter the referring health care providers social security number with no spaces or hyphens.Block 18: Enter the hospitalization dates, if applicable.Block 19: Leave blank.Block 20: Check the appropriate boxBlock 21: Enter up to four ICD-9-CM diagnostic codes in order of priority.Block 22: Leave blank.Block 23: Enter any assigned managed care preauthorization number.Block 24A: Enter the month, day and year [MM/DD/YYYY] in the from column. Do not enter to date unless the insurance carrier requests it.Block 24B: Enter the place of service code.Block 24C: Enter the type of service code.Block 24D: Enter CPT codes or HCPCS codes as applicable. Separate modifiers with a space, not a hyphen.Block 24E: Enter the diagnosis reference code from block 21 that best proves the medical necessity for each service listed in block 24E.Block 24F: Enter the fee.Block 24G: Enter the days or units for each line item. This block should be used for multiple visits for identical services, number of miles, units of supplies or oxygen volume. If anesthesia service, enter the beginning and end time of administration.Block 24H: Leave blank.Block 24I: Place an X in this block if the service was provided in a hospital emergency room.Block 24J-24K: Leave blank.Block 25: Enter the providers employer federal tax ID number [EIN]. If there isnt one, enter the providers social security number.
Block 26: Enter the patients account number, if one is assigned by the provider.Block 27: Leave blank.Block 28: Enter the total charges.Block 29-30: Leave blank.Block 31: Providers signature or SIGNATURE ON FILE and date.Block 32: Enter the name, address, city, state, and zip code of the place services were provided, if other than the providers office or patients home.Block 33: Enter the name, complete address, and telephone number of the providers location. PIN# and GRP#: leave blank.
About the Author
Dr Guptha Trainer for the ICD10 Training online
Bouchercon 2008: Lawrence Block Charles Ardai
This is a Guest of Honor Interview of author Lawrence Block by Charles Ardai. Filmed by Stacey Cochran using a Panasonic HPX170.
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