Low Worker’s Comp Payments Merit Action

March 28th, 2013

Physicians who serve patients with employment-related injuries are acutely aware of the absurdly low reimbursement rates that insurance companies typically offer. But often, they do not realize that they are not powerless to act.

While“write-offs” are commonly agreed to when participating in group health insurance networks, Medicare or Medicaid, the write-offs typical in the worker’s comp field do not have to be taken lying down. You can deposit the initial checks that come, then take your claim for the remainder of your bill to the Virginia Worker’s Compensation Commission for relief.

The Commission process is very friendly to physicians and their groups. First, it is an administrative process, not a court process. This means that the vast majority of claims are resolved based on paper submissions, with only modest discovery obligations and usually without any need for the physicians or their staff to appear in court. There are no case filing fees to pay, either. With just a little help from your staff, your lawyer can get to work on improving your bottom line.

Second, the Commission offers physicians a presumption that their standard rates of charge are acceptable. Unless and until the insurance company produces evidence that the amounts charted are excessive, the health care provider is customarily awarded the full balance due from the amount originally billed. No more write-offs!

While every case has its own unique aspects, given a volume of underpaid accounts, your lawyer should be able to improve your net realization rate out of your worker’s compensation billings. At The Marrs Law Firm, we represent many physician groups across Virginia, and we have handled literally thousands of worker’s comp account claims for them. Occasionally an individual file will see challenges. But overall, every one of our clients has seen new revenues from discovering and accessing the Commission’s procedures.

Physicians and their administrative staff should also understand that membership in worker’s compensation insurance networks is usually a terrible deal for the physicians. As in group health insurance networks, the physician or group commits to accepting heavily discounted payments. But unlike the group health situation, there is almost never any increase in patient volume in return. We typically recommend that worker’s comp networks be avoided (or exited if need be).

If a physician still prefers network membership, at the very least he or she should know that network reimbursement rates and other contract terms are negotiable. In addition, the network’s standard form contracts contain many overbearing provisions that should definitely be stricken from the documents before signing is considered. Never let anyone tell you it’s a “take it or leave it” situation; our clients regularly prove that it is not.

Whether in or out of the networks, you can do better. All physicians should ensure that their chief administrators know this, so that their groups’ financial performance in worker’s comp cases can be all that the law means for it to be.