A Guide to Workers' Compensation Physical Therapy Guidelines for PTs

Best Practices for Navigating Workers’ Compensation Claims

1. Ascertain the Work-Related Nature of the Injury

The initiation of workers' compensation billing hinges on verifying that the patient's injury is work-related. Suppose a patient neglects to inform the therapist of the work-related nature of their injury. The provider might mistakenly bill the patient's primary insurance in that case. This oversight can lead to complications, such as the need to return reimbursements and initiate appeals, consuming valuable administrative time.

2. Scrutinize the Workers’ Compensation Claim Details

Upon confirming the work-related nature of the injury, it's imperative to validate the specifics of the workers’ compensation claim. Typically, a claim will encompass:

• Adjuster's name
• Patient's name
• Claim number
• Patient's date of birth
• Injury date
• Affected body part related to the claim

Moreover, many insurance carriers mandate the inclusion of an approved diagnosis on the claim. If the PT isn't the diagnosing provider, they must be apprised of the diagnosis before commencing treatment.

3. Engage with the Adjuster for Treatment Authorization

Before initiating treatment, the PT must communicate with the adjuster named on the claim. This dialogue determines if the insurance is part of a payer network, dictating the claim submission process. Securing a written treatment authorization is crucial, as verbal confirmations lack tangible evidence in case of claim denials.

4. Diligently Document Each Authorized Visit

For successful claim processing, PTs must meticulously record all authorized visits. Any discrepancies between the service dates, visit count, and the approved diagnosis can result in claim denials. If additional treatments are required, the adjuster should be promptly informed. Furthermore, many payers necessitate submitting patient documentation alongside the claim, emphasizing the importance of accurate record-keeping.