How to Collect Workers’ Compensation Effectively Good relationship with adjusters is key BY ROBERT KURTZ


he good news: Workers’ compensa- tion collections can be easy. The bad

news: There are several obstacles that can make a simple experience difficult. “While workers’ compensation col- lections is similar in many ways to col- lecting from insurance companies, ele- ments of the process are unique,” says Ken Bulow, president of Zulu Health in South Pasadena, California. “ASCs must understand these aspects or they run the risk of failing to collect in full or losing money on workers’ compen- sation cases.” Perhaps the most significant differ- ence between workers’ compensation and most managed care plans is that ASCs will typically work with a single person for a workers’ compensation case, Bulow says. “This individual— an adjuster—helps the injured person with his or her claim.” The claim may include many matters besides medical care. This adjuster will control whether an ASC is paid. “Find out who that adjuster is as early as possible, prefer- ably before you see the patient.” Establish

a good rapport with

adjusters, Bulow suggests. “You are likely going to need their help with some issue or question.” When work- ing with insurance companies, you can usually reach someone who can assist with questions or concerns, whether by phone or online portal. For work- ers’ compensation cases, communi- cate directly with the adjuster. “If he or she is not taking your calls, it will make the process much more diffi- cult,” he says. Such experiences are why Jessi Hammond, RN, director of Piedmont Surgery Center in Macon, Georgia, says workers’ compensation is “all about relationships.” To help ensure Piedmont maintains positive relationships with


its adjusters and achieves successful collections for its roughly 100 annual workers’ compensation cases, the ASC has a staff member assigned as a work- ers’ compensation coordinator. “She is essentially the liaison between Piedmont and its adjusters,” Hammond says. “She handles every- thing from A to Z, from making sure we have all the information needed to schedule a patient’s appointments, coor- dinating communications and making sure nothing falls through the cracks that could delay care or impede payment.” Imperative to collections success is understanding your ASC’s state

and carrier requirements governing workers’ compensation, Bulow says. Some states have workers’ compen- sation fee schedules while others do not. “For those that do not, you will need to come to an agreement with your carriers on a reasonable payment for procedures. This is particularly important when performing high-cost cases requiring implants. Each state has its own laws concerning work- ers’ compensation appeals, and some have a short time period to complete the process.”

If you provide great care, maintain good communication and submit the documentation the carrier requires, the process should be easy and result in your getting paid in a timely manner.”

— Jessi Hammond, RN Piedmont Surgery Center

On the carrier side, learn whether

you need to secure an authorization before proceeding with a surgery, he says. “Find out if the carrier is set up to process documentation electroni- cally. Many are not.” Also critical to receiving payment

on workers’ compensation cases: per- forming the correct procedure, Bulow says. “A patient may come to you for a procedure to treat back pain caused by their work. This patient may also be seeking treatment for joint pain attributable to running. If you treat the injury that is not covered by the work- ers’

compensation carrier—in this scenario, the joint pain—you are not going to get paid.”

Hammond says that if you learn the

workers’ compensation billing pro- cess and follow it carefully, collec- tions efforts should prove successful. “What is nice about workers’ compen- sation is that you have the employer, which pays for the surgery, wanting the employee to get taken care of as efficiently as possible. If you provide great care, maintain good communica- tion and submit the documentation the carrier requires, the process should be easy and result in your getting paid in a timely manner.”

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