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MARYLAND WORKERS COMPENSATION & MEDICAL BILLS ATTORNEY

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Medical Bills and Maryland Workers Compensation

When an employee is unfortunate enough to be injured on the job many concerns immediately cross their mind such as ability to continue working.  One of the more alarming concerns for injured workers is how they will be able to pay for the medical treatment they need.

Fortunately enough, Maryland workers compensation laws provide that medical treatment is to be paid by the employers workers comp insurer.  Unfortunately bills are often not paid in a timely fashion, or go unpaid leading to a collections notice and/or threatening phone calls.

For medical providers and injured workers alike, getting bills paid is a frustrating and confusing process. However, with a little research and a few inquiries this process can be made a little easier.

The Maryland Workers Compensation Medical Bills Fee Schedule

The amount billed by a physician for a particular service is most likely not the amount they will receive from the workers compensation insurer.  Similar to health insurance, workers comp insurance pays at a different rate than the physicians billing rate.  Those physicians, medical providers, medical facilities that accept workers comp agree to be paid according to the rates established by law.  These rates are indicated in the Workers Compensation Commission Medical Fee Guide found here.  Each year the rates may be adjusted for one or any number of medical service provided with any changes being reflected in the updated Fee Guide publishing.  The Maryland workers compensation Medical Fee Guide Committee was established in 2002 to review the methodology that the WCC utilizes to regularly review physician fees. The Committee is charged with recommending a method for developing and regularly updating a multiplier to be used with CPT codes.  They are also charged with the responsibility of recommending  the best approach for distributing and annually updating the Fee Guide.”  The Committee consists of injured workers attorneys, insurance attorneys, doctors, and a Commissioner.

To use the Maryland Workers Compensation Fee guide the medical provider must first have the proper CPT (Current Procedural Terminology) code.  Once the proper CPT code is acquired a mathematical equation must be performed to find the proper reimbursement rate.  The equation can be found here for those who are interested in learning how to calculate the reimbursement rates.

Hearings for payment of Medical expenses and bills in a workers compensation case

Quite often medical bills are not paid by the workers compensation insurer or are not paid timely.  This can be frustrating to medical providers and occasionally leads to their decision to refuse workers compensation insurance.  It can also be extremely   Medical providers should be aware that they do not have to accept that workers compensation is not paying them for the services rendered and there is assistance available to obtain payment.  On a daily basis there are hearings at the Maryland Workers Compensation Commission for the purpose of getting medical providers paid. 

In almost every  Maryland workers compensation case there is at least one medical bill that is not paid timely or goes unpaid so you will regularly hear the injured workers attorneys request payment of bills at the hearings.  Outstanding bills may relate to almost any medical service provided or medical supplies issued.  Some common examples are surgery bills, anesthesia bills, physical therapy bills, MRI, Xray, or other diagnostic bills,  medical clinic bills such as Patient First or Express care, Urgent Care or Concentra Medical Center.  It is even more frustrating, even entering the realm of absurdity when a simple orthopedic brace, cast, or splint is not being paid. 

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Forms related to Medical Bills in workers compensation case

What is the medical provider to do to get their bill paid if there is no workers compensation attorney representing the injured worker?  Referring the injured worker to a Maryland workers compensation attorney is always a possibility however it is not necessary.

Proper formatting billing with proper CPT codes should be submitted to the workers compensation insurer responsible for the claim.  The insurer has 45 days from the date of receiving the bill to pay the bill or file a notice of denial of the bill.  There is the potential for a fine and penalties be assessed against the insurer if they do not deny or pay the bill within 45 days of receiving it.  If the workers compensation insurer denies the bill then a Claim for Medical Services form may be filed.  Once the form is filed the practitioner may receive payment, or may have to attend a hearing before the Workers Compensation Commission.

If the medical provider wishes to seek out payment for medical services they have provided there are a number of forms they should familiarize themselves with.

HCFA FormThis format of billing is required by workers compensation laws and most insurers will not pay bills without use of the HCFA form. Medical providers that are not familiar with this form may be unaware this is the reason the adjuster is not paying their bill.  Often Acupuncturists do not bill in this format which leads to non-payment.

Issues Form – this form is one of the most common form used in Maryland Workers Compensation cases as it allows parties on both sides to request a hearing for any number of issues including payment of medical bills and expenses.

Form C51 Claim for Medical Services- The Claim for Medical Services form is submitted to the workers compensation commission for review, compliance with the fee schedule, and eventually an Order approving the medical bill and requiring the insurance company to pay the bill will be issues by the Workers Compensation Commission. 

Order Nisi- This is not a form but it is necessary to understand the Order Nisi when pursuing payment of medical bills.  The Maryland Workers Compensation Commission will issue this Order when it finds medical bills are to be paid by the workers compensation insurer.  The insurer will receive a copy of this Order Nisi. The Order may also amend the amount payable, find some, all, or none of the bills payable by the workers comp insurer.

Form H32 Controversion of Medical Claim-  The workers compensation insurer will have 30 days to object to the payment of the medical bill by filing a Controverys of Medical claim form.

Factors that may be considered by adjusters when deciding to willingly pay workers compensation medical bills

  • Was the bill properly submitted using the HCFA format?
  • Have the medical reports been submitted with the bill, have the reports been submitted piecemeal, or are there some medical reports the adjuster may not have?
  • Do the reports include language that relates the need for treatment to the accident that occurred at work?
  • Is there currently an Independent Medical Evaluation (IME) scheduled that may determine the causal relationship of the treatment and payment thereafter.
  • What is the standard of care for such medical treatment and was the treatment excessive, clinically necessary, and reasonable?
  • Are there modifying factors that may indicate a higher rate of payment under the workers comp fee guide?

 

More Related Reading:

Workers Comp Medical Bills and frustrated Doctor, Lawyer, and Injured worker

 

For a no cost consultation with Maryland Injury Attorney Andrew M. Rodabaugh call  +1 (410) 937-1659     , Email ,  or fill out the form below:

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