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Our specialized coders and billers have extensive experience adhering to federal and state laws, AAPC, AMA, and HIPAA regulations, and insurance payer billing guidelines and fee schedules. Their expertise helps us assist healthcare providers in securing complete service reimbursements. The experts have years of experience getting maximum reimbursements by filling out forms like the First Report of Injury Form, CMS-1500, and more. Here is how we simplify the entire billing process for you:
- Leverage workers compensation-specific billing software coupled with digital data platforms such as EDI, EHR, EMR, and PCS to facilitate electronic claims submission and electronic payments.
- Check with carriers regarding the coverage details for certain types of treatments or procedures for workplace injury or illnesses.
- Assign correct billing codes such as ICD-10 codes, HCPCS Level II codes, and CPT codes (surgery codes: 10000–69999, E/M codes: 99201–99499, diagnostic services: 80000-89398, physical therapy: 97001-97799) for rendered services.
- Comply with billing laws and regulations of various jurisdictions (country, state, or region) to ensure adherence and avoid potential penalties or fines.
- Adhere to the fee schedules and payment guidelines set by insurance payers including state managed insurance funds, specialty insurers for high-risk businesses, professional employer organizations (PEOs), and others.
- Maintain code specificity and regulations while handling different types of billing for workers compensation including value-based payments, fee-for-service, capitation, global billing, DRG billing, case rate billing, APC billing, utilization review billing, etc.
- Submit clean claims to the appropriate workers' compensation insurance providers such as Travelers Insurance, The Hartford, Zurich North America, Liberty Mutual Insurance, Nationwide, State Insurance Funds (e.g., New York State Insurance Fund, California State Compensation Insurance Fund), etc. for timely reimbursements.
- Review Explanation of Review (EOR) to understand the specifics of what the insurance has covered regarding a claim.
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