Until March of this year, with record-low unemployment and a healthy labor market, hospitals were seeing a steady and consistent revenue stream from workers’ compensation (WC) claims involving typical workplace injuries and illnesses. Managing these WC claims was laborious, but updates to state laws occurred annually, allowing for significant lead time to implement changes, and only a small percentage of WC claims were disputed and litigated. As a result of COVID-19, many states have implemented mid-year changes to their WC coverage rules, more WC claims are being challenged and litigated, and the amount of work required to navigate this changing environment has increased significantly.
As this article is being written, new WC laws have been passed, or governors have issued executive orders in 15 states that expand or more clearly define who may qualify for WC benefits due to COVID-19 exposure. Covered benefits include testing, lab work, lost wages, and medical coverage. Commercial payers will be quick to monitor and deny claims covered under these new laws, specifically for members that they know are frontline workers or healthcare professionals. Are you aware of the changes that may have taken place in the states where your facilities operate?
Patients treated in the ED who believe that they have COVID-19 due to exposure in the course of their employment (essential workers) will tell your patient access department that the illness is work-related and should be covered by their employer. They may refuse to make copays and insist that the employer be billed. It is imperative that your patient access staff gather all employment information and that the treating physician documents the patient’s chart fully and accurately. Have you provided updated training to your patient access staff and physicians to ensure proper information gathering occurs?
Billing staff will have to do a more thorough job validating the WC claim with the payer and ensuring that the COVID-19 illness is covered. Supporting medical records from the treating physician will be critical to ensuring these bills are paid timely. WC claims are going to be disputed and litigated at a higher rate for COVID-19 patients. Do you have robust procedures in place to handle these accounts? You must ensure that you are protecting your timely filing options with secondary payers if the WC claim is found not to be the employer’s responsibility and is disallowed. Are your billing and follow up staff prepared with the latest legal updates and changes to ensure your WC claims are billed and paid timely?
COVID-19 has had a significant impact on all aspects of our healthcare system, including revenue and margins. WC COVID-19 claims will add more work for your already-overextended resources and can significantly impact your bottom line if you are not prepared.