With the rise in patient responsibility — partially due to the rise in high deductible health plans — there has been a noticeable decrease in patient collection rates which can impact a hospital’s overall revenue.
If you’re looking for ways to improve the revenue cycle and maximize your workers’ compensation reimbursements, you need to look at the entire process, not just the back office.
How to Increase Workers’ Compensation Reimbursement
When a patient walks through your doors, there’s a good chance they are feeling a variety of emotions including fear, anxiety, and confusion. In this fragile state, they are handed a clipboard with multiple pages of questions, hospital policies, and HIPAA verbiage — none of which are easy to understand.
This is the beginning of a poor patient experience, and we know that happy patients are more likely to address their financial obligations more quickly. If you want to know how to increase your workers’ compensation reimbursement, you need to begin at the first point of contact: the registration desk.
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Schedule a ConsultationReimbursement Begins at Registration
For workers’ compensation claims, the registration process is more invasive than a “check the box” process; there are many nuances that are outside of the clinical purview. Fundamentally, the process is not only the beginning of patient care at the hospital, but also the beginning of the revenue cycle.
Hospitals that fail to identify work-related claims at the point of registration are in for a long road paved with delays, denials, and takebacks. Optimizing patient registrations needs to be the priority focal point of a workers’ compensation registration strategy.
The first step to optimizing this strategy begins by training registration staff to ask five essential questions.
Don’t assume that patients will know to assert the information on their own or that the workplace connection will become obvious during the treatment process. Once you know the incident is work-related, determine if the state in which the employer/patient resides requires you to file an injury report. Depending on the state, the deadline for completing the form may be as short as 24 hours. There’s no time to waste.
Unlike traditional health insurance, patients are unlikely to know the workers’ compensation payer that is responsible for their company’s coverage, so it’s imperative to ask patients where they work. Specifically, you will need to document:
- The employer’s name
- The employer’s address
- The employer’s main phone number
- The full name of the person responsible for being your main contact at the employer
Expect some hurdles, and be prepared to follow pre-authorization policies, employer direct-pay programs, and regulations that apply to the payer and the state workers’ compensation program.
The injury form requires you to provide not just a summary of the patient’s current medical condition but also a summary of:
- How the injury occurred
- Where it occurred
- The date on which it occurred
- Whether this is the first visit or a follow-up visit for this specific injury
Be prepared to collect a full description of what caused the injury or illness, an explanation of why it’s work-related, as well as full contact information for the injured worker.
Unlike traditional health insurance, most patients will not know the workers’ compensation payer that is responsible for their company’s coverage. Therefore, it is imperative that you document the name and contact information of the patient’s employer correctly.
This information needs to be obtained during the registration process in the event the patient’s work compensation payer denies the claim. When obtaining your patient’s health insurance information, remember to ask them about the policyholder because sometimes the patient is covered under their spouse or parent’s policy.
Once you have optimized the patient registration strategy, the next priority should be implementing a strategy to work towards hitting your financial goals with the greatest impact on your organization.
Improving your revenue cycle and increasing your workers’ compensation reimbursements is easy when you partner with EnableComp. From patient registration to reimbursement, our proprietary claims management software, E360 RCM™, is the most efficient workflow engine in the marketplace with built-in reimbursement modeling, underpayment identification, and embedded federal/state/company reimbursement rules — providing you with the highest yield and best-in-class outcomes in less time.
