Workers’ comp billing is a different animal, operating under state-specific rules and fee schedules and featuring a thousand challenges that don’t come up in group health or Medicare billing.

Accordingly, most Revenue Cycle Management (RCM) software for general medical billing isn’t up to the task, something most providers only discover after things start to go wrong. Billing through a clearinghouse has serious pitfalls, and billing on paper is wildly inefficient.

Below are 5 common billing problems practices face when treating injured workers, all of which are telling you one thing: it’s time to switch to comp-specific electronic billing (e-billing) software.

This way, you’ll get paid in full and on time.

Sign 1: Payers Report Your Bills as "Not on File."

You got authorization, treated the injured worker, and submitted the bill. Then, crickets.

When you finally realize you haven’t been paid, you chase the claims administrator down, who tells you the bill is “not on file.” It’s not the first time.

There are just too many things that can go wrong on a bill’s journey from your practice to the payer. Paper bills get lost or separated from their supporting documents (and move glacially through the postal service). Faxes fail. Bills you hand off to a clearinghouse have to be rerouted, sometimes right into a ditch.

The result: constant resubmissions, and a longer and longer time frame where your revenue sits in Accounts Receivable instead of in your bank account.

daisyBill has direct electronic connections to each of the major clearinghouses that accept workers’ comp e-bills on payers’ behalf. Plus, e-bills and their supporting, digitized documentation stay connected with a unique attachment control number. The whole package takes the most direct route possible to the payer.

Sign 2: Payments Take Months to Arrive.

There’s no valid reason for your practice’s revenue to sit in Accounts Receivable for months on end.

With paper billing, clearinghouse rerouting, and shoehorning software for group health into the comp workflow, delays and “lost” bills and documents are likely. Moreover, there’s often no way to know when payers miss deadlines to respond.

Comp-specific software not only tracks reimbursements, it tracks deadlines. When there’s no response to your bill, you get notified. Bird’s-eye view analytics also reveal patterns of late payment, so you can identify which payers are the worst offenders.

Sign 3: Payments Consistently Fall Below Fee Schedule or Billed Charges

In the majority of states, state fee schedules dictate what payers owe for most workers’ comp procedures. However, payers routinely underpay by:

• Applying outdated rates
• Applying invalid discounts
• Substituting their own incorrect calculations

Comp-specific software compares billed amounts, fee schedule rates, and actual reimbursements to reveal where payers came up short.

Sign 4: You Can’t Keep Up With Fee Schedules

Speaking of state fee schedules, they are complicated, voluminous, and can change multiple times per year.

Standard RCM software has no idea what the reimbursement amounts should be according to the fee schedule rate for the location and date of service.

For California and New York, daisyBill updates with each change to the fee schedule, so providers always know exactly what to charge. Each line item comes with a downloadable breakdown of the reimbursement calculation that will withstand any amount of scrutiny.

Sign 5: You have no idea whether 1-4 are happening

For some providers, all of the problems above are occurring, but perhaps not visibly, quietly wearing away at revenue and making treating injured workers a financial liability.

It’s easy to mistake the absence of data for the absence of a problem. If you don’t have useful analytics that provide a clear window into workers’ comp revenue, you might never know that missing, underpaid, or late bills are costing your practice.

Every practice should be able to find the following data quickly and easily:

• Average days to payment for comp bills
• Percentage of comp bills paid at fee schedule or billed amounts
• Amount of revenue missing due to unresolved bills

See our webinar on workers’ comp financial benchmarks for a detailed look at the power of analytics. When it comes to keeping workers’ comp financially viable for your practice, the metrics matter.

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