The novel coronavirus has caused minor and major chaos in just about every aspect of life, so it should come as no surprise to you that your worker’s compensation claims are now more complicated than ever.
“There are more layers to these types of claims,” says David Rothgerber, Argos Health’s senior vice president for workers’ compensation services. Be aware, he says, that the additional complications may cause revenue stream disruption if you aren’t on your toes.
Here’s what you need to know.
Essential workers who show up in your emergency department with COVID-19 symptoms may believe that their medical expenses related to the diagnosis and treatment of the virus (if it comes to that) should be covered by their employer’s workers’ compensation policy. In their minds, they got the virus on the job, so workers’ comp should cover. However, that may not be the case.
COVID-19 is a disease, and in many states, this category of illness, which includes colds and the flu, is not covered by workers’ comp. Some states allow workers to get workers’ comp coverage for particular diseases if they can prove the disease was directly related to their work – but the onus is on the employee. And there are a handful of states that presume certain conditions are attributable to employment – firefighters who end up with cancer or first responders who are diagnosed with PTSD, for example.
With essential workers facing heightened exposure to COVID-19, a number of states are expanding or considering expansion of workers’ compensation laws, so these workers have unhampered access to workers’ comp benefits.
In these states, emergency legislation amends (or seeks to amend) workers’ comp policy so that COVID-19 infections are presumed to be work-related, and therefore covered by workers’ compensation, for particular workers – usually essential workers such as nurses, paramedics, firefighters, and retail and grocery workers.
While efforts to support the nation’s frontline workers are laudatory, these changes to workers’ comp may cause revenue stream disruption for hospitals in those states where the amendments are happening, says Rothgerber.
“As a hospital, you need to be able to ensure that you’re submitting the claims to the right payer at the right time or else you’re going to spend a lot of time and resources getting denials, rebilling, and trying to obtain additional information, which is all the work we do,” he said.
To stay on top of these workers’ comp claims, he recommends that your registration or patient access staff be made aware of the changes to state law and given proper training so that the information that needs to be captured gets captured from the get-go.
Your registration or patient access staff should be asking patients about their employer and what sort of work they do and whether or not they believe the potential virus diagnosis is related to their employment – the same questions they’d be asking for traditional, work-related physical injury presentations.
“If the registration staff just registers someone and doesn’t find out where they work or if they believe that this happened during their work – especially for those people who don’t have insurance – you may never get that person back in the hospital; you may never be able to track them down to bill them,” Rothgerber says.
If you are located in a state that doesn’t cover diseases and hasn’t made any amendments to allow for COVID-19 coverage, do not assume that patients aren’t eligible for workers’ comp benefits. The claim could still be covered if the employer has made that arrangement with their workers’ comp insurance provider, for example, he said.
In such cases, be aware that getting such claims covered may still be burdensome. The patient/employee may likely have to provide proof that the claim is related to employment, which will slow down the claim recovery for the hospital.
To help expedite such situations, it is a good idea for the hospital to, once again, get as much information at registration as possible, he says. It also may be a good idea to get your billing staff to be proactive: have them call the patient’s employer to make sure they have notified their workers’ comp insurer by filing a first report of injury. Since COVID-19 coverage may be new to the employer, the employer may not know to submit that documentation, causing more delays.
And if the patient’s employer doesn’t cover the workers’ comp claim, you already have the information you need to send the claim to the patient’s commercial insurer, if the patient has insurance coverage.
It’s also important not to assume that you won’t get paid when a low-wage essential worker without health insurance comes in, he says. Don’t immediately send such claims to self-pay or charity care. “If they don’t have health insurance, the only way you’re going to get paid is finding another source of payment, which could be workers’ comp,” he says. “I have a feeling a lot of these patients are going to self-pay, and they’re going to get written off, and the hospital will never collect anything.”
If your staff is trained to ask questions about employment at registration, even for those patients with government or commercial insurance, it puts you in a better position to get paid. “Right now, hospitals are very stressed financially due to COVID-19, so this is just another way for them to ensure that they’re finding revenue in every area they possibly can,” he says.
No matter the insurance or workers’ comp coverage situation, these are complicated claims, so expect your billing staff to do a lot of work. It’s likely to be a lengthy and frustrating process to go through. “A lot of these may be disputed or denied or litigated because of the newness of COVID-19 claims being caused through the course of employment,” he says. “We are focused on monitoring the claims to ensure that your facility ultimately gets reimbursed.”
Looking for a partner to help you manage your worker’s comp claims? Argos Health handles workers’ compensation claims from start to finish. Learn more about our workers’ comp services by going here or filling out our contact form here.