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Workers Compensation Medical Bills

workers compensation medical bills

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WORKERS COMPENSATION MEDICAL BILLS    

THIS WEBSITE IS THE PRODUCT OF A WORKERS COMPENSATION ATTORNEY AND IS NOT AFFILIATED WITH  ANY WORKERS COMPENSATION INSURER.  FURTHER IT IS NOT AFFILIATED WITH THE STATE OF MARYLAND NOR ANY GOVERNMENT ENTITY WITHIN THE STATE OF MARYLAND.  Information contained herein is provided for informational purposes and expresses opinions and information best known at the time it was written.  This information and does not create an attorney to client representation.

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 law mandates workers compensation medical bills are 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 workers compensation medical 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.

 

For a free consultation call Baltimore workers compensation attorney and personal injury attorney Andrew M. Rodabaugh at  Call Us, Click to email  or just fill out the form at the bottom of the page and Mr. Rodabaugh will contact you!

 

Hearings for payment of workers compensation medical bills and expenses

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 frustrating for injured workers, and literally painful because they may have difficulty obtaining medical care ongoing.  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.  

Forms related to workers compensation medical bills

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 formatted 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 Form–This 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 workers compensation medical bills.  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 Controversion 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 of the workers compensation medical bills 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?

 

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 workers compensation medical bills rate may be adjusted for one or any number of medical service provided with any changes being reflected in the updated Fee Guide publishing.  The 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.  Along with the CPT, the relative value units will be needed.  The RVU can be found using this calculator once the CPT codes are acquired or they can be found here.  There are more factors involved when running the equation for workers compensation medical bills rates however that will be discussed in a different article.  For those in need now:  The equation and relative information can be found here .

For a free consultation call Baltimore workers compensation attorney and personal injury attorney Andrew M. Rodabaugh now at  Call Us, Click to email  or just fill out the form at the bottom of the page and Mr. Rodabaugh will contact you!

 

My experience with the law firm of Cohen and Dwin was very professional. Mr Rodabaugh was very kind and easy to talk to in a very professional manner. The receptionists were helpful in guiding me through the procedures. I would definitely recommend Mr Rodabaugh in the future.
David B.CosmotologistBaltimore

 

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Maryland workers compensation attorney Andrew M. Rodabaugh and his office offers information about Personal Injury law and Workers’ Compensation for informational purposes only. Nothing contained herein constitutes formal legal advice. If you need the advice of a Maryland workers compensation lawyer, please contact him today. He has offices throughout the state and various convenient meeting locations.  Each and every case needs to be evaluated before legal advice can be provided.  Under no circumstance should the information on this website be considered medical advice. This is an attorney’s website and is not affiliated with any government agency or government entity of any kind.
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Summary
Workers Comp Coverage Attorney
Service Type
Workers Comp Coverage Attorney
Provider Name
Andrew M. Rodabaugh Esquire,
Baltimore,Maryalnd,MD- Telephone No.410-937-1659
Area
Maryland
Description
Workers compensation medical bills often go unpaid until an attorney is hired. Workers compensation attorneys can file for hearings and produce proper documents to get the workers compensation medical bills paid timely.