Should You Add Workers’ Comp to Your Medical Practice?
Nearly 3.6 million occupational injuries and illnesses are treated each year in the United States. Those injured workers need somewhere to go for treatment, and many companies are irritated with the long wait times their employees face at the local emergency rooms. Additionally, most employers want a one-stop shopping-clinic model for all their occupational medicine needs.
Your Medical Practice has the potential to fill this niche in your community. If your clinic is already offering drug screens, physicals, and pre-employment testing, adding workers’ compensation care to your practice has the potential to grow your business margins exponentially. Additionally, it has the potential to generate a large number of referrals to your clinic. Consider this, Concentra, one of the nation’s largest occupational medicine clinics, was bought by Humana in December 2010 for $790 million. With over 300 medical clinics in 42 states, Concentra makes over $800 million a year in revenue. *
What is Workers’ Compensation?
Simply put, workers’ compensation is the standard term given to injuries acquired on the job. In actuality, workers’ compensation is the type of insurance available to injured workers to cover lost wages and medical benefits for employees injured while at work. Making the decision to become a workers’ compensation provider means your Medical Practice will bill to workers’ compensation insurance companies.
Workers’ Compensation Rules and Regulations
The rules and regulations governing workers compensation vary by state. Each state has a governing board that oversees the workers compensation systems. For the sake of this article, we will examine workers compensation in Texas. This will give you a starting point for researching the workers’ compensation regulations in your state. In Texas, the Texas Department of Insurance Division of Workers’ Compensation is the governing board. Texas private employers are not required to participate in the state’s workers’ compensation system. Companies who elect not to participate are known as “non-subscribers” to Texas Workers Compensation. This means they are not governed by the state, and in trade, not protected by the state. It is important for you to know if the companies who utilize your services are subscribers or non-subscribers to the state system.
Credentialing and Workers’ Compensation
Because workers’ compensation is a type of insurance, credentialing with work comp carriers is just as important as credentialing with private payers. If you are not credentialed, you may get a lower reimbursement for being an out-of-network provider. Different companies utilize different workers’ compensation insurance carriers. As you start to acquire new companies who agree to utilize your services, you should contact their work comp carrier and get the information on how to get credentialed with them. Each insurance will have different requirements for credentialing, so it is very important you find out exactly how they want it done.
Verifying Patient Benefits
Unlike regular patients who walk in the door with private insurance and the authority to request their insurance be billed, injured workers must have a pre-authorization before being seen. Therefore, it is important for you to set-up a system with the individual companies to verify an employee may be seen as a worker’s comp patient prior to treating them. For more information on this, see our article on Workers' Compensation Billing. There are two ways to set-up verification. First, you can require your companies to send injured workers into your clinic with an authorization for treatment. Some companies may not have a large enough staff to do this. Your other alternative is to contact the employer directly and verify they sent the inured employee in for treatment. Verification protects both you and the employer by ensuring you are treating a legitimate workers comp patient and not billing claims to the employer’s work comp carrier that they did not authorize.
To ensure you keep the companies you work for happy as you handle their workers’ compensation injuries, you should set-up protocols to follow with each company. A protocol is simply a set of instructions on what to do when an injured employee comes in to your clinic for treatment. Protocols should include information on if employees need a drug screen and who to contact if the patient needs to be referred to a specialist. The protocols should be kept in a place where anyone in your Medical Practice clinic can access them when an injured worker shows up at your Clinic. If your Medical Practice utilizes an electronic medical record (EMR), it is a good idea to enter the protocol into the employer’s contact information in the software.
Learn Disability Guidelines
If you have never treated injured workers before, it is important you are familiar with the official disability guidelines (ODG). These guidelines outline how to treat the most common work-related conditions, include return to work guidelines, and go over impairment guidelines. The information contained in the ODG serves as a great workers’ compensation reference for all medical providers.
If you offer workers compensation at your clinic, you should also offer drug testing. Most employers require post-accident drug screens when an injured employee comes into your clinic. By offering this service, not only will you make additional revenue during the visit, but you will also make it easier on the company who sends the employee to you for treatment. For more information on drug testing, see our article on Drug Testing & Your Medical Practice.
A Tale of Two Customers
Being a workers’ compensation healthcare provider is a fine balance of keeping two customers happy: the injured employee and the employer. By giving the injured employee the best medical care possible, along with the proper restrictions so he/she does not further injure him/herself, you can help improve the employee’s life and ability to return to work. For the employer, you have the obligation to treat the injured worker in a timely fashion, keep diagnostic testing to medically necessary, and to give the injured employee the restrictions to keep safe, so no further injury occurs on the employer’s watch.
*Statistics for this blog came from a presentation at the 2011 Annual Meeting of the California Orthopedic Association.