Worker’s Compensation cases are extremely complex, have added costs for the physician not associated with cash or insured patients and can also take several months or even years to be paid. It is understandable that many physicians are apprehensive to take on Worker’s Comp cases, in new or well established patients, because of the complicated criteria and the long wait on overdue payments from the Division of Workers’ Compensation (DWC). California’s workers’ compensation law allows certain claims for payment for services or benefits provided to or on behalf of injured workers to be filed as a lien against an injured employee’s claim for workers’ compensation benefits. Payment of those claims can only be allowed by order of the Workers’ Compensation Appeals Board (WCAB).
The application process for workers’ compensation requires the filling out and submitting of a claim form. An employee may also be required to submit other documents such as medical records. If the claim is filled out incorrectly, relevant information is missing, incomplete or bad reports or an employer rejects the claim, then the employee may have to appeal. The appeals process can be lengthy and costs can be absorbed in litigation so doctors often have to settle for a small portion of the billable services rendered.
Therefore, a slight error in documenting a workers’ compensation case can prove very expensive, the insurance can deny payment or treatment plan and the case could end up in litigation and cause enormous delays in getting reimbursed for the services provided, hence it is extremely important to make sure your reports are absolutely impeccable.
We at Acutrans, understand that treating physicians take on a lot of risk treating patients on a lien. We have transcribed millions of Workers’ Compensation reports over the last 12 years and know the language and technicalities of these extremely critical legal reports.
We have a 3 tier process of transcribing a work comp report:
1) We look at the doctor’s completed schedule and decide which template/form is to be used for which patient.
2) We take the PIS(Patient Information/Intake Sheet) and fill out all the demographic details into the template.(This is a time consuming task that distracts from patient care as well as the time doctor has to see patients).
3) Finally, We begin the actual transcription of doctor’s dictation. Doctors will not dictate many headings like past medical history, current medications, social history, etc. Our transcribers look at the Patient Intake Sheet and decipher the patients hand writing and insert that into the report. They also go through the doctors Physical Exam sheets and incorporate those observations into the report at the appropriate places. Transcribers look at lab reports, x-rays, and also incorporate those findings at the appropriate places in the report. Doctors may also send referring physicians’ and independent medical reviewers’ (AME/QME) letters/reports and request that those be inserted into the diagnosis or treatment plan to further support history and treatment.
Physicians will usually dictate only history of present illness, treatment plan, and diagnosis. All other headings in the report will be researched by the transcriber by looking at all the relevant paperwork like Insurance Correspondence, Patients Prescriptions, etc. A detailed report covering all aspects of the patient’s history, presenting injury/illness, review of systems, review of medical records if any, the physical examination done by the treating doctor, the assessment and the treatment plan including referrals, and any diagnostic testing if needed is prepared.
Once the transcription is complete, we then have to look at the treatment plan, diagnosis and insert the appropriate ICD-10 codes for the diagnosis and prepare a Request for Authorization (This process is referred to as “coding”). This consists of itemized requests for evaluation/treatment (referrals, MRI and/or other tests, therapy, medications, etc.), the medical basis for the requested treatment (specific diagnosis/diagnoses), and the ICD-10 codes for the diagnoses.
The transcriptionist’s job does not end here; we also prepare a “Proof Of Service” and envelopes needed to mail those documents. In the case where there is any missing information which the doctor forgot to dictate, or if there is any contradiction or if they forgot to send us some supporting paperwork, we will send a request to the clinic, wait until it arrives and then complete the reports. It can take a lot of time to complete each report, the actual amount of time of dictation might be very small, but the responsibilities of the transcribers are enormous. We are able to turn our reports around in 12 hours because we hire very experienced, well trained staff. Your completed report along with the RFA (Request for Authorization) is ready to be served within 12 hours. We also have a 3-tier editing system so that absolutely no detail falls through the cracks. This is the big reason why Voice Recognition or EHR software can never work for a work comp clinic, it needs human expertise to prepare accurate reports.
Managing workers’ compensation claims is more complex than ever. Several forces are driving this environment, including a vast array of legal, legislative and compliance demands as well as state-specific regulations and benefits, thus requiring insurance carriers and third-party claim administrators (TPAs) to have a high degree of jurisdictional expertise. In addition, emerging issues such as an aging workforce, narcotic use and the growing incidence of chronic health conditions among injured workers have made recoveries longer and more complicated—and can make claims more expensive. Given the complicated process serving patients in the Workers’ Compensation system, it is more important than ever to provide the kind of accuracy in reporting necessary to see a lien get paid. Although workers’ compensation claims are becoming increasingly complex, a combination of new solutions, expertise, and technologies provides the opportunity for optimum outcomes for even more complex, challenging claims. Outsourcing medical transcription services provide medical offices huge cost savings in their overhead in hiring, training, salary, benefits and liability insurance. Additionally, the accuracy, expertise, quick turnaround time and efficiency provided by a professional transcription service increases the speed and potential of resolution in WC cases.
Medical Records play an increasingly important role in managing Workers’ Compensation claims today and driving optimal outcomes. Information is documented at every stage of a claim, from the first report of injury to settlement or return to work. This information can be analyzed and then used proactively in several ways, enabling case managers to act quickly and proactively to assign the claim to the right adjuster, direct it to a nurse case manager when necessary and identify when to intervene with the injured worker, pharmacy or physician. It can also inform decisions involving legal counsel and settlements.
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