Workers’ Comp Intake Shouldn’t Be a Doctor’s Nightmare. We Must Standardize It or Face Debilitating Consequences

By: | January 19, 2022

Catherine Montgomery is a founder of DaisyBill, a dedicated workers’ comp billing software and services provider. Her crusade to improve medical billing through technology began in 2005 with the founding of Clarity Medical Billing Resources, a trusted free resource for workers’ comp stakeholders. In 2011, Catherine cofounded DaisyBill to bring greater efficiency, transparency, and fairness to workers’ compensation.

Of all the inefficiencies that plague workers’ comp, patient intake stands out for the sheer amount of administrative “friction” encountered by the doctors who treat injured workers.

That’s largely because unlike Medicare or group health care, workers’ comp has no digitized or even standardized way of quickly and easily accessing patient information.

When a Medicare or group healthcare patient arrives at a practice, they typically present a card, from which administrative staff can instantly access demographic and insurance (read: payment) information.

But in workers’ comp, collecting this payment information is a painstaking, time-consuming manual process for practice staff — one that’s trapped in the information infrastructure of the pre-Internet past.

California’s Workers’ Comp Program

California is a perfect example, where strict regulations make meticulous record-keeping a must. Upon first intake, California workers’ comp doctors must gather the usual patient demographic information, including the patient’s name, Social Security number (sadly, this is a required field in CA workers’ comp), date of birth, gender, and home address.

But in addition to that, the doctor needs:

  • the injured workers’ employer’s name
  • the date of injury
  • the claims administrator’s name
  • the claim number
  • the claims administrator’s physical billing address
  • the adjuster name and telephone number
  • the employer Medical Provider Network (MPN)
  • the primary treating physician for the injured worker
  • the fax number for sending Requests for Authorization (RFAs)
  • the electronic payer ID number for the claims administrator’s clearinghouse
  • the injured body parts for which the employer accepts liability

Failing to gather this information has consequences.

Without knowing the accepted body parts, the doctor cannot know what to treat. Without the claim information, the doctor cannot bill. Without the MPN name, the doctor cannot even know whether they’re even allowed to treat the injured worker. Without the RFA fax number, the doctor cannot obtain the approval required for every single treatment or prescription.

None of this required information is standardized or in a convenient digital repository. Instead, for each injured worker, California regulations require the practice to devote enormous administrative resources to obtaining these critical details — often requiring multiple phone calls and significant amounts of time.

Even more frustrating, claims administrators fail to adequately staff call centers to help doctors obtain this information, as agents of our managed billing service can attest.

For example, claims for over 200 injured California workers were recently transferred from one third-party administrator (TPA) to another, after which the new TPA changed all of the claim numbers. When our agents called for the new claim numbers, the automated system’s anticipated hold time was 45 minutes. The actual hold time was over an hour and a half.

Treating Injured Workers 

How can providers (particularly those without an external billing service like ours) be expected to treat injured workers under these conditions?

Why would any reasonably self-interested provider choose to fill their schedule with injured workers when treating group health and Medicare patients is so much less frictious — and so much more financially sustainable?

Workers’ comp needs what most of the rest of the medical industry already has: a system whereby required injury and claims information is standardized and provided to doctors by the insurers and employers.

A great deal of ink is spilled each year reporting on the frictional costs associated with workers’ compensation treatment.

Currently, states like California address these rising costs in the most wasteful possible manner. Fee schedule rates rise to cover administrative expenses. Payers and networks pour resources into undercutting those fee schedule rates. Doctors lose money, time, and sanity treating injured workers, so they simply stop treating these patients.

Instead of trying to compensate for its inefficiencies with only nominally higher reimbursement rates — which payers will only strive to undermine, leading to costly, wasteful disputes — workers’ compensation should devote resources to smoother, less redundant, more modern information management.

Workers’ comp owes employers and injured workers that much, at least. &

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