Workers’ Compensation accounts are a problem for many hospitals because they require a disproportionate share of business office resources. That’s because of the number of parties involved -- and because the business office often lacks the resources to stay on top of the specific requirements of workers’ compensation law.
Workers’ Compensation accounts typically require the involvement of multiple parties, including the carrier, employer, patient, patient's attorney, and a state or federal agency. Navigating and negotiating with all of these parties requires frequent contact and can place extraordinary demands on hospital staff.
Carriers often require extensive detail to determine the compensability of the employee's claim. This includes a report of injury being filed by the employer to show when and how the accident occurred and what kind of injury took place. Carriers also typically require itemized statements and medical records prior to processing a claim, and they may request additional supporting documentation, such as implant invoices.
The controlling law for filing and payment of workers' compensation claims depends on the type of employer and the employer's location. Each state has laws that direct its employers on the extent of workers’ compensation coverage required with some states allowing employers to be uninsured, paying any workers’ compensation claims directly out-of-pocket.
Some states have mandated fee schedules while other states allow payment at a "usual and customary" or "fair and reasonable" rate. While hospital staff may be familiar with the workers' compensation laws of the state where the hospital is located, they often do not know the laws of other states which come into play for out-of-state employers. Additionally, the U.S. Department of Labor administers benefits for certain federal workers.
RSource specializes in workers’ compensation account resolution with a team of expert attorneys and claims professionals who understand and confidently navigate the filing and payment guidelines of all 50 states and the federal government. RSource takes an aggressive approach, pursuing reimbursement through persistent telephone contact and legal-based payment demands to ensure prompt bill processing.
Workers Compensation Program accounts are typically placed at Day One.