If you are a first health provider, it is in your interest to begin the claim process by filing the Worker and Physician’s Report of Industrial Injury with the Industrial Commission of Arizona.
It is also important to periodically check with the patient/injured worker to see if the claim has been “accepted" or “denied" by the insurance company. That typically occurs within one month from the date the claim is filed. If the patient/injured worker is unable to provide the information, contact the Industrial Commission at (602) 542-4661 to determine the status of the claim. It can be financially costly to continue treating a patient with a denied claim. However, once the claim is accepted, you must bill pursuant to the Arizona Industrial Commission Fee Schedule. The workers’ compensation claim payment is limited to the Arizona Industrial Commission Fee Schedule. This Fee Schedule is available on the Industrial Commission’s website: http:www.ica.state.az.us.
Also, keep in mind that the claimant/injured worker is not responsible for payment of any disputed amounts between the medical provider and the insurance company.
Medical office staff must provide billing to the insurance carrier in proper format and within a timely manner. The bill will either be paid in whole or in part, within thirty days from the date the claim is accepted, if the billing is received before the date of acceptance, or within thirty days from the date of receipt of the billing if the billing is received after the date of acceptance. A billing denial may be based upon any reasonable justification.
The next important billing issue is the timing of the initial bill or any bill. The doctor’s office should bill the insurance carrier periodically and throughout treatment. Do not wait more than the 24 months from the last service or the bill will not be paid.
If the claim were litigated, it would be wise to bill the carrier periodically, even though it is in litigation because at least the carrier has “received" the bills. In other words, do not wait until there is some finality to the litigation before you bill. It could be over two years before it is final. Let the bill be rejected and then send it back. At least there will be record that the bill was sent and the service was properly billed during the statutory two-year period.
Robert Wisniewski, Esq. has the experience and skills necessary to help injured workers through the claim process. When a doctor's office has questions, he can provide information to ensure that all services are considered for payment. Contact The Law Office of Robert E. Wisniewski at (602) 234-3700 to schedule a free consultation.