Worker Comp Claims Of Assistant Surgeon

Submitting a Worker comp Claim for Assistant surgeon might look easy, But, It’s not. It could be tricky with various Carriers. Now am going to Share some Experience while working on Assistant Spine and Podiatrist surgeon (NY State), If you have any suggestions to make or you that I have skipped any important part than please feel free to message me anytime.

 

  1. Getting a Claimants/Patients Information

Now, At the time of visit most Practices take WC claim info e.g Date of accident, SSN, Claim number for responsible carrier (if they have) some time Employer do not obtain claim number/WCB number from Board or they does not report Injury, In that case we might want to contact employer to get the information. But, Most of the time Injuries were reported to Board Already. Always and Always take SSN from the patient, You might miss date of Injury, but don’t worry about that because WC board guys are very helpful. They will provide you everything you need. E.g – Carrier name claim number and Adjusters Information,

Second – If employer has already submitted Injury to board than we don’t have to worry about it, we can simply initial C4 to WC board thru Fax, Online Submission or thru Mail. Most Practices send Claim form thru mail which  takes time to process,

There is another way to send initial submission thru Fax, which would be very easy and convenient : http://www.wcb.ny.gov/content/main/forms/Howtofax.jsp    and very easy submission is thru their online portal : http://www.wcb.ny.gov/content/ebiz/WEBForms/webform_HCProvider.jsp#c4  ( User name and Pass Required)

  1. Preparing a Claim

Am Not going to talk about CODING because there are many factors related to surgery, LCD NCD NCCI edits and Coverage. When surgeon was assistant in surgery than most of the Time I use 80 81 82 and AS modifier based on above factors.

 

Claim Form Submission :

Billing Clark send Claim form of Primary Surgeon and Assistant surgeon in One Envelope which is wrong. They always think that they are sending same patient claim to same Carrier than why not I use same Envelop,

I am not saying that he/she can’t do this,  they can. Some insurance process a certain claim separately for Different provider But some do not. I don’t want to say their name, but surgeons already know that which insurance is a Pain in the neck.

Carrier may deny claim saying Duplicate or saying – there is one more claim for the same patient which is already processed hence cannot process this one (they have processed this claim for Primary Surgeon)

Now, what can we do here?

We can use different envelope. In the second envelop we can send a Letter stating that this claim is for Assistant in surgery.

Sometime I send license copy of assistant surgeon along with the letter, doing this my claims denial reduced to 40%.

Many providers do not know that claims can be send Electronically, some EMR/EHR does have these capability. And you can send OP/Medical notes electronically as well. This will definitely expedite reimbursement.

Some Clerks might wanna send claim thru Fax. You can do it, But, not when DOS is not 45 days old.

My suggestion is to get in touch with Carrier and can ask for privilege for sending fax for claim submission for newer DOS instead of submitting Claim thru Mail or thru Electronic format.

Currently I am sending Fax to some carrier after taking permission. You can also do that by paying some additional fee to your responsible carrier.

I have not covered claims denials and working with WC Board and Carrier because different cases have different terms.

Have Any suggestion ……:) !

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