TOP TEN LIST OF HOW TO WORK TOGETHER TO GET BILLS PAID

1. Legible bills—when presenting medical expenses to the Board, we have to produce the actual bill and a list of the entire amount outstanding if multiple bills. The Board has to be able to determine what dates of treatment are outstanding and what treatment was performed on any given day. If we don’t have this, the Board is going to rule that the treatment was not reasonable and necessary. Due to the diversity of computerized bookkeeping formats, our paralegals may need to call your office for clarification of charges and treatment performed.

2. Medical records—we have to produce medical records to support the bill at issue. If your outstanding bill is $250 and the copying charge is $100 to obtain the medical records to get your bill paid, it becomes a dilemma. Please remember that your patient is ultimately paying for your copying charge.

3. Legible records—we have to be able to determine what parts of the body and what treatment was performed on any given date. We have an RN that will review records—we will only call for clarification if she cannot decipher them.

4. Record content—whatever is in or not in the medical records can determine the outcome of the case. Content is often used to attack the claimant’s credibility.

5. Last minute requests for the most recent records—these records can be crucial at a deposition and it is often beneficial to have your patient seen very close to the date of the deposition. Often-times we have just been made aware of the most recent visit. We make every effort to request the records in advance.

6. What parts of the body are injured—we often hear that when the patient initially comes in, both the back and neck had pain, but because one or the other is worse, the focus is on the most symptomatic. There may be several months to a year gap while the main problem is being addressed, especially if surgery has been performed. Once that is resolved, attention is then refocused on the secondary injury. The lack of any mention of the secondary problem in the records leads to the carrier denying any treatment related to that injury because there has been a gap in treatment. Trying to overcome this by testimony can be difficult.

7. Understand that just because you have sent the client the bill doesn’t mean they have provided it to us. Please feel free to send us a copy.
   
   
8.   Medical testimony—how much will the deposition testimony cost versus how much is the bill. If we have multiple issues going to a hearing and can add the medical bill, great. But if the sole remaining issue is a bill, for example, a $3000 chiropractic or surgery bill, to be cost effective, we cannot proceed if there is also going to be an $1800 medical witness fee. The carrier only reimburses medical witness fees if we are successful at a hearing. If there can be an accommodation by waiving prepayment of the deposition fee then are fine in going forward and trying to get the bill paid. If we are successful, we ask the carrier to pay the medical witness fee.
   
   
9. Understand that as advocates for our clients, we may have to add a doctor or facility as a party to the petition. At the very least, we need an agreement that the facility or the provider will abide by the Board’s decision on what is reasonable and necessary and will not proceed against the client for the additional balance.
   
   
10. Treatments that are most likely to be challenged include: chiropractic, physical therapy, additional diagnostic testing, newly developed procedures or testing.

DISABILITY NOTES:

            One of the main issues that comes up in every worker’s compensation case is whether someone is totally disabled from any and all jobs or whether they can work with restrictions. When the carrier files a Petition to Review on whether or not the claimant can work, this information is vital. In order to know how to proceed at the hearing, we have to know the doctor’s opinion on the ability to work and have to produce that to opposing counsel. If a disability note or work restriction is provided at the time of the office visit to the client, we are able to obtain this information. When we request medical records, we would ask that you include disability notes as well.

PIP VS COMP 

            When in doubt, put bills through worker’s compensation. Both PIP and worker’s compensation pay for lost wages and medical bills. However, PIP has a dollar limit and a time limit. Worker’s compensation does not. In addition, PIP’s wage benefits are at net (usually 80%) while worker’s compensation pays at 66 2/3% up to a maximum compensation rate that is currently $610.67 per week. Therefore, to make sure the claimant is maximizing the benefits to which he is entitled, the medical bills should be processed through worker’s compensation.