Worker’s Comp Medical Billing: Adjusting to the New Statute of Limitations

June 1st, 2016

On March 15, we posted a report on how the statute of limitations adopted by the General Assembly in 2014 was substantially affecting clients’ ability to collect upon claims for underpayment in the worker’s comp system. To review that report, please reference the March 15 blog post.

As an update, we would add the following two key points for consideration.

First, because the statute’s one-year clock starts ticking when the insurance company makes its LAST payment for any date of service, many insurance companies are no longer willing to entertain provider requests for reconsideration of the initial, low ball payments. Any supplemental payment would extend the time the provider has to file a claim, so insurers are simply refraining for making later payments.

Before the statute of limitations went into effect, savvy providers often noticed that when the initial low ball payments arrived, at least some additional money was there for the asking if the billing staff pressed for reconsideration. As we move forward, providers’ business offices will notice that the efforts of their billing staff will bear less and less fruit.

Because of this, there is no reason for a provider to cling to a file after the insurer’s initial payment has arrived. The insurer is unlikely to issue any supplemental payments, so staff expenses spent pressing for supplemental payments will be money wasted.
In addition, the longer a provider hangs on to any particular file, the more likely it will become that part or all of that claim will be lost to the very short limitations period.

We are now urging clients to review their files with us at least once every six months. This will allow ample time for the insurer to conclude its initial payments, while still assuring that we have the ability to file your claims well before anyone could contend the claims were forfeit under the statute of limitations.

Our second key update point is that because the language in the 2014 law, intended to make the insurer’s ability to invoke the one-year rule contingent upon its having abided by prompt payment positions, was not as clearly written as it should have been, insurers are now looking to test the efficacy of that language by arguing that no such condition exists. That is, insurers want to be able to invoke a statute of limitations defense even if they did not deliver prompt payment. We are currently handling a test case brought by one insurer, and we expect to have to fight that case until all appeals are exhausted.