Medical Billing Concept - Worker Compensation

What is WC


WORKERS COMPENSATION is a requirement of the federal government for employers of patients who are injured or become sick on the job. It is operated by various plans chosen by the employer or can be operated by state governments. There is a Bureau of Workers Compensation (BWC) who administers the workers compensation system. Employers may pay premiums into a state insurance fund or to an insurance or managed care plan to administer their workers compensation funds. Some large employers have been granted the privilege by BWC of having their own workers compensation program.

There are five types of compensation for on-the-job injuries and illnesses.

1. Medical treatment and rehabilitation
2. Loss of wages (disability payments)
3. Permanent disability (payments in one sum or weekly or monthly payments)
4. Vocational rehabilitation
5. Compensation to the dependents of employees who are fatally injured (death benefits)

For claims submission, the most widely used form is CMS 1500 though certain carrier require their own forms to report injury claims. However all of them require the employer information and the injury date on the claims. Without this information no workers compensation claim would get paid. The amount paid by the workers compensation carrier to the provider is in full and final settlement of the claims. If there is any dispute, we can appeal in the form sent by the carrier within the time limit mentioned therein. On no account should the patient be billed for the balance after a workers compensation claim has been paid.

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