Official Medical Fee Schedule (OMFS) – unfortunately doctors, or those who handle their medical billing, often have no idea that they are entitled to more compensation for a given course of treatment. Instead, they accept the first payment which is often lower than their full compensation and do not pursue the balance. Insurers have 60 days to pay under the new law governing this. As a result the doctor’s office or their billers write off the balance. With no one trained to pursue and follow up doctors are left with no billing recourse and their accounts receivable goes up accordingly.
The Medicare Physician Fee Schedule (MPFS) provides more than 10,000 physician services, the associated relative value units, a fee schedule status indicator and various payment policy indicators needed for payment adjustment (i.e., payment of assistant at surgery, team surgery, bilateral surgery, etc.). This enormous database is extremely complex. Not understanding what standard fees and terms are for a given treatment costs physicians millions of dollars every year. We can help you make sure you’re getting the proper payment for your services, as well as get them paid in a timely manner.
An important distinction in workers’ comp claims is that while the policyholder is usually the patient in the group health arena, the employer is the subscriber in the workers’ comp sector.
Also, what is usually called an explanation of benefits (EOB) in a patient-insured claim is an explanation of review (EOR) in a workers’ comp case. And instead of a claim being identified with your regular healthcare identification number, in workers’ comp cases you use a case file or claim number.
There is no deductible or copayment linked to workers’ compensation claims. Providers must accept the compensation payment as paid in full as billing the injured worker for any outstanding balance is illegal.
If a patient has an injury treated without mentioning that it occurred at work, your practice would bill his or her primary insurance. However, when the patient later suggests that his or her employer’s insurance should be charged for the medical services, it is your practice’s responsibility to bill the workers’ comp insurance and return any original reimbursement to the primary payer.
There is no book written, no website that exists anywhere that can address the shifting and complex nature of Worker’s Comp Billing and Collections. That is why over the last 25+ we’ve built the best team in the industry, provided them with the very best tools, training and systems so that they can excel.
If you or your staff have billing questions that relate to Worker’s Comp feel free to contact us and we will do our best to help – (949) 863-0022 or use our contact form.
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