Medical billing concept - Worker compensation - Part 1

Where is information available for medical providers treating patients with injuries/conditions that may be the subject of a workers’ compensation claim?

The North Carolina Industrial Commission website. The Industrial Commission is the state agency responsible for administering the Workers’ Compensation Act.

http://www.comp.state.nc.us/

The Workers’ Compensation Act is contained within Chapter 97 of the North Carolina General Statutes and is available at:

http://www.comp.state.nc.us/ncic/pages/ch97toc.htm

The Industrial Commission has promulgated Workers’ Compensation Rules in accordance with the Workers’ Compensation Act which are available at:

http://www.comp.state.nc.us/ncic/pages/comprule.htm

The NCIC Medical Fee Schedule which governs reimbursement amounts for medical treatment is available at:

http://www.comp.state.nc.us/ncic/pages/feesched.asp

The NCIC Rating Guide which provides guidelines for evaluating permanent partial impairment is available at:

http://www.comp.state.nc.us/ncic/pages/ratinggd.htm


How can a medical provider verify workers’ compensation coverage and the responsible party for payment for treatment related to an employee’s on the job injuries?

Contact the self-insured employer, workers’ compensation carrier or administrator and obtain written authorization for treatment.

How can a medical provider determine an employer’s workers’ compensation carrier?

The workers’ compensation insurance carrier for an employer may be identified by visiting the Commission’s website at http://www.comp.state.nc.us/iwcnss/


Do HIPAA regulations change the procedure of sending medical records with the workers’ compensation bill?

No, HIPAA law does not preempt state law on workers’ compensation and should not impede the billing process.


What reimbursement amount will a medical provider receive for treatment of workers’ compensation patients?

A medical provider’s reimbursement is limited to the maximum amount approved in the NCIC Medical Fee Schedule. In cases wherein a specific CPT code or procedure is not included in the NCIC Medical Fee Schedule, the parties may privately contract for a mutually agreeable payment amount. N.C.G.S. §97-26(a)

Where should a medical provider send the bill for payment?

The bill along with the medical records should be sent to the employer/carrier/administrator, not the Industrial Commission.

How long does a medical provider have to submit a bill to the payer?

A provider of medical compensation shall submit its statement for services within 75 days of the rendition of the service or if treatment is longer, within 30 days after the end of the month during which multiple treatments were provided, or within such other reasonable period of time as allowed by the Industrial Commission. However, in cases where liability is initially denied but subsequently admitted or determined by the Industrial Commission, the time for submission of medical bills shall run from the time the health care provider received notice of the admission or determination of liability. NCIC Workers’ Compensation Rule 407(2)

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