Disability and Workers Comp

(Chris Lacroix) #1

I have had several membership patients who have gotten hurt on the Job and have missed or been taken out of work while I was taking care of him or her. During the patient’s care we may have various labs, X-rays and or other procedures that have been preformed in the office for this care. Some of these items are included in our monthly fees and others are not.
Several of these patients have come to me wanting me to submit bills to their workman’s comp for reimbursement. How are these fees accounted for when some are included and others are separate from the monthly membership fee? I have also received similar questions from Attorney’s in relation to cost of expected care for several patients looking for settlements from his or her injury. Any help her is welcome.

(Dr Phil Eskew, DO, JD, MBA) #2

Most DPC practices either include workers comp within the membership fee, or elect to bill for it separately. Including it in the membership fee can sometimes lead to obligations to file a fee for service zero dollar claim so that the incident can be tracked by the state. Unless you are being paid directly by an employer that wants you to bundle workers comp then it will likely make economical sense for you to NOT bundle workers comp services with your DPC services. The patients typically don’t have any copays in workers comp situations so they will not mind that this is not included in the membership, and the paperwork and payment procedures for these cases are usually streamlined in most states compared to other FFS reimbursement systems (private insurance, Medicare, etc).

(Dr. Peter Lehmann) #3

We notify our patients that we do not do work-related claims. We explain to them that this typically involves lots of paperwork that is typically billed out to the state. We have had no complaints.

(Appalenia Udell, Esq.) #4

Hi Chris,
Just to add-on to Phil’s comment, you can have a separate fee-for-service
or a la carte schedule in addition to your membership fees and submit that
schedule for reimbursement. This also comes in handy for infrequent
visits, usually made by a member’s visiting relatives and such. When
calculating on-going care costs, make sure to work in a margin for
negotiations or the time-value of the funds if you’re accepting a
third-party lien. I hope that’s helpful.

Appalenia Udell, Esq.

(Chris Lacroix) #5

Thank you for your responses @philsq @appalenia, they have been very helpful. Prior to a month ago this issue only came up once, and in the last 30 days we have had several cases come up. We have tried to handle these issue through our a la carte pricing, as @appalenia has mentioned, but have had one family not understand the difference between the monthly membership and the workman’s comp claims. On that note since we are new at processing Workman’s comp claims, is there something that has to be filed seperately with the state, or does the workman’s comp processor take care of this once we submit our claim? Also, we previously had been approached by a couple of small companies about covering workman’s comp claims if we became their DPC provider. I initially did not know how to handle the question, and just let it go along with the potential buisness, but if we were to negotiate workman’s comp as as part of the covered expenses in our fees for a particular company, how and who would I submit the “zero fee” to?

(Dr Phil Eskew, DO, JD, MBA) #6

In Wyoming you would need to register with the state and be paid by the state when you filed the paperwork. I can’t speak for all locations. States will vary in their requirements regarding zero dollar billing as well. In an ideal world this is not necessary.

(Appalenia Udell, Esq.) #7

I believe you are in NC, is that right? It looks like they have a more fluid approach to WC and you may need to file additional 18m or other forms, depending on the situation. There is a lot of benefit to DPC-WC synergy and I can understand why an employer would find that attractive. California used to have a similar capability that was significantly impaired when they switched from AMA guidelines to ACOM guidelines; prior to the switch, doctors loved it because they developed a fluency with typical injuries particular to that employer. Legal counsel would be advisable here, let me know if you need a referral.

(Dino William Ramzi) #8

I am on the border between Oregon and Washington. Our contracts explicitly state that labor and industries claims are billed separately. We have a relationship with Washington [we are registered and enforce them through a non-clearinghouse mechanism]. There is no requirement to register in Oregon and we supply invoices directly to the employer. It is a state administered state wide self-insurance contractor to a private company and paid for either by direct invoice (which works great for me) or through a TPA. We are in the midst of our first Oregon best claim going through a TPA and I intend to be very aggressive collecting payment directly from the employer Due to my inability to go through the TPA. Ask me again in a couple of months how it went