Workers Compensation

The Worker Compensation claims process can be slow and laborious trying to identify employers, determine who is paying for the bills and manually follow up with those payers. Authorizations and treating diagnosis codes complicate the process further.

JP Recovery Services, Inc. (JPRS) is a partner that works as an extension of our client’s office for Day-One Workers Compensation payers.  All account balances would be referred to the JPRS Medical Billing Division for review and resolution. The division is currently staffed by more than 40 experienced billers, certified professional coders (CPC) and customer service representatives.

FRONT END PROCESS

  • JPRS will review and update unbilled accounts in the client’s accounts receivable system via unbilled list, report or work queue to determine the correct claim number and payer.
  • ER/Urgent care accounts will be researched for First Reports of Injury (FROI).
  • FROI’s with State Insured Managed Care Organizations (MCO’s) will be filed online
  • Self Insured payers will be sent to the correct party (employer or Third Party Administrator TPA) via fax
  • First reports of injury are reviewed and processed within 24 hours in most cases.  If we are not able to locate the correct payer, the patient may be contacted to expedite claims processing.

BILLING

  • Registration will be completed fully so that subsequent visits indicated the correct Payer information
  • JPRS will review and resolve edits in the client’s billing system. Coding issues can be moved to a work que for client review
  • After release, accounts can be automatically listed to JPRS via secure FTP site
  • Late charges/corrected bills will be submitted and followed through to resolution
  • JPRS will fax bills & required medical records to all payers and client notes will be updated

FOLLOW UP

  • Payer websites are effectively utilized to locate payments & denials

  • Phone call follow up will be utilized to determine reason for nonpayment at 14 days to expedite processing

  • Hearing denials are followed up with BWC reps to ensure their hearing status is current.

  • Denials for modifiers, units, HCPCS, revenue code issues will be reviewed and updated in the billing system.

AUTHORIZATIONS

  • Denials for authorizations will be reviewed and the physician of record or ordering physician will be contacted for C9 completion and signature so that the retro C9 can be processed and addressed by the payer.

  • Retro authorizations will be filed on payer websites or by fax. Volume of appealed accounts can be reported back, if needed.

  • Diagnosis denials will be carefully reviewed and physicians will be contacted if new diagnosis codes need to be added

  • Reoccurring physician issues will be reported back to for physician education.

REMITTANCES/DENIALS/PAYMENT OVERVIEW

  • Remittances are reviewed for underpayments.

  • Invalid denials will be appealed for all balances.

  • Financial class changes will occur to move the balances after BWC denial to the other payers not worked by JPRS or patient. Missing explanation of benefits (EOB) will be saved into the clients imaging system.

  • JPRS staff are trained to process write offs under $5000. Credit balances are work as directed

  • Key account follow-up will be recorded in Clients accounts receivable system.

  • Accounts will be handled to full exhaustion and closure

  • Monthly standing meeting to discuss any processing obstacles.

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