Although medical practices that focus solely on workers’ compensation claims do exist, even more medical providers accept workers’ comp cases along with regular patient appointments.

Accepting different types of insurance such as workers’ comp can help practices gain top-line revenue — as long as billers submit claims data in a way the insurer will readily accept. Studies vary, but some medical practices have clean claims ratios as low as 65%, which means 35% of claims need to be reworked, efforts that delay payment by days or weeks and cause additional work for already overburdened back-office staff. Those delays cost practices an estimated $20 billion a year in delayed or lost reimbursement.

Workers’ compensation cases can be particularly troublesome because insurers require documentation of the work-related illness or injury and progress toward recovery, increasing the onus on practices. State regulations about claims filing differ, but electronic claims are generally accepted and paid more quickly than paper ones. However, unwieldy methods of attaching files or reworking claims create problems for medical practice staff who often resort to snail mail or fax machines, delaying reimbursement further.

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