Even before the outbreak of the novel coronavirus, workers’ compensation claims posed significant revenue cycle management challenges for healthcare facilities. If a work-related illness or injury is overlooked initially—whether because the PAS misses it or the patient does not sufficiently disclose information—the patient’s primary insurance is charged for services. Responsibility then falls to the hospital to rebill the workers’ compensation insurance and return original reimbursement to the primary payor.
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In the face of so many potential errors, achieving reimbursement for workers’ compensation claims is rarely cost-effective. Mounds of paperwork and changing requirements complicate an already difficult process. Now, with the outbreak of COVID-19, health systems are facing even more ambiguity on what constitutes a work-related illness.
Traditionally, workers’ compensation coverage is not extended to community-spread illnesses such as the flu because it is hard to identify the root cause of exposure. However, some states have reconsidered their workers’ comp regulations because essential workers—such as grocery store employees and healthcare staff—are at higher risk for contracting the novel coronavirus because of the nature of their work.
One response from several states across the nation has been to amend legislation so that COVID-19 infections in certain workers are presumed to be work-related, which means employers and insurers must prove that the virus was not contracted on the job in order to avoid paying.
In short, many coronavirus cases—especially those in essential workers—are likely to be eligible for workers’ compensation reimbursement. However, because these regulations change frequently and differ across states, healthcare facilities must remain apprised of policy updates in order to follow correct procedures and ensure timely collections.
With millions of dollars in revenue hanging in the balance, you cannot afford to leave your workers’ compensation claims to chance. At Aspirion, we investigate and determine correct payors, obtain all the necessary paperwork for claim submissions, and aggressively follow up to make sure all claims are resolved and paid. Contact us to find out how we can increase your revenue through workers’ compensation claims management best practices.