Medical Billing Forum

General Category => General Questions => Topic started by: jcbilling on May 10, 2011, 01:42:02 PM

Title: Workman's Comp
Post by: jcbilling on May 10, 2011, 01:42:02 PM
We have a new client that is telling us that since their provider does not accept workman's comp, we can bill the commercial insurance on file.

My first response is "That is sooo not right!" But where do I go to prove it?

The patient was hospitalized due to dehydration & heat exhaustion during employment.

Title: Re: Workman's Comp
Post by: Michele on May 12, 2011, 06:36:40 AM
I always thought that if a patient was workers comp and the provider didn't take workers comp that they couldn't treat the patient.  The commercial carrier will deny as work related if they are aware of the comp claim.  They don't care if the provider doesn't take comp.  I'm not sure where to get documentation on this though.  Anybody else??
Title: Re: Workman's Comp
Post by: DMK on May 12, 2011, 11:04:03 AM
In California at least, you can not bill the patient or their private insurance if it's a known worker's comp case.  They would need to go where the carrier authorizes them to go.  If it's the initial treatment, the employer should have a directive as to where they're supposed to go for initial treatment.  If it's a "hospital" do they have a choice to take comp or not?  Again, in California, the initial visit is ALWAYS paid for, so they would get paid, but follow up treatment would have to be authorized.