Workers Compensation Billing and Collections

Basics of Workers Compensation:

Worker's compensation, commonly known as worker's comp, is a type of insurance that covers the treatment of injuries occurring on the job. Employers typically purchase commercial worker's comp policies directly, although some states administer these policies. Medical billers must therefore remain aware of the worker's comp policies for their state, including their limitations and differences from other types of medical insurance

Atlas Medical Management, LLC is highly specialized in California State Workers' Compensation claim billing and recovery. When we submit your bills we are able to recover 95% of the authorized billing within the first 45 days of the claim submission and within 90 days the 100% of the authorized billing.

On AME QME billing, we have consistently recovered our clients' bills within first 60 days of submission. Our thorough knowledge of DWC Laws, Labor Codes, CCR and Medical Billing and payment guide enable us to help our clients through the complete cycle of evaluating and/or treating an injured worker.

Areas we focus on to recover money from workers compensation payers.

• E-Billing: The State of California has mandated that every payer be able to accept electronic billing, although many providers are still submitting bills on paper. We are able to submit bills electronically to all payers through our state-of-the-art software, which enables us to collect faster on due bills - our average fastest payment comes in three days and the latest average is about fifteen days.

• Documentation: When it comes to workers' comp, documentation is the most important part, as the injured worker's case depends largely on the reporting of the Primary Treating Physician or AME QME. Payers need reports to process medical bills, so lapses in this area are common. Our AI-enabled billing program makes sure all bills are submitted along with the required reports, and secures transmission report logs back into bill records. We also provide compliant and accurate transcription services for workers' compensation cases to keep clean and clear documentation of the case.

• Request  for Authorization: California workers' comp allows medical treatment that is reasonable and necessary to cure or relieve an injured worker from the effects of injury, meaning treatment that is based upon the ACOEM treatment guidelines adopted in the MTUS. On behalf of medical provider's, we prepare all authorization paperwork submit it to UR's or Adjuster and follow up. Authorization requests are submitted within one business day of receiving patient information.

• Second Bill Review: SB 863 made it necessary to request second bill reviews on bills not paid according to the official medical fee schedule (OMFS) within 90 days of payment. Payers often don't pay according to OMFS guidelines, so it becomes necessary to request timely second bill reviews (SBR) from payers. If the bill is still not paid according to OMFS guidelines, we request an independent bill review (IBR). Our knowledge of Second Bill Review, Independent Bill Review (IBR) process, OMFS and Labor Code facilitates expedient resolution to denied and underpaid claims. Appeals occur within 7 days of denial or partial payment.

• Lien Filing. SB 863 made it mandatory for providers who treated the patient on a lien basis to file a lien with DWC within 18 months of the last service date. If that provider's office fails to do so, the dues officially become unrecoverable and hence lose money in the process. Our AI enabled program provides us daily reports of accounts which are due for filing liens 30 days in advance so we never miss any deadline; apart from this, we will file case-watch on EDEX so we keep getting case updates which are automatically logged in patient accounts, so no treatments are provided if the case is settled.

• Lien Negotiation: Many payers want to offer pennies for providers' liens. We tackle them with case facts, bill reviews and our excellent negotiation skills allow us to collect the maximum amount on our clients' liens. We have established long-term contacts with defense attorneys, adjusters which also helps us recover our clients' liens more quickly. If our in-house collectors fail to settle the lien in house, we aggressively file the DOR and set the matter for hearing or trial. In preparation for this, we prepare petitions for costs and penalties for maximum recovery on behalf of our clients.

• WCAB Representation: Having experienced and knowledgeable attorneys at your side is a big plus when representing the provider's lien at the WCAB board. We have extensive experience in managing and representing our clients across all boards at the State of California, and we have demonstrated rich collection experience.

Atlas Medical Management, LLC is one of the leading billing and collection service companies in the workers' compensation arena. We have a established track record of collecting the maximum for our clients, whether it be e-billing, medical transcription, aggressive collection - we have you covered. Reach out to us at info@atlasmedicalmgmt.com or call us 562-375-0472 for a tailored solution to your specific billing and collection needs.