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Background

Worker’s compensation programs provide benefits to workers injured on the job. Benefits include payments for medical care associated with treating work related illness or injury. Each state and the District of Columbia has its own program. There are also programs to cover federal employees.

Since work comp programs are designed and administered by the states, work comp programs vary in terms of who is allowed to provide insurance, which injuries or illnesses are compensable, claims administration, treatment guidelines, and benefit levels.

Therefore, normal billing patterns in healthcare cannot be applied to work comp because the nature of processing claims and the payer system is fundamentally different and unique. In the work comp environment there are no eligibility systems, billing is paper based, collections are difficult, and cash application is manual.

Difficulties of Workers' Compensation

• Each state has different workers compensation laws and schedules. State fee reimbursement schedules are changing more rapidly.
• Many parties are involved in every claim – employers, injured employees, insurance companies, government agencies and, of course, healthcare providers.
• Eligibility standards don’t exist – employment, injuries, and payers must be determined case by case.
• Much of the highly complex workers compensation documentation process remains locked in a paper world – paper that’s easily misfiled or lost.