Pub. 2 2020 Issue 4

Why AmI Getting a Bill; This Is Workers Comp? MARTA J SILAKKA RN, BSN, CCM, COHN-S NURSE CASE MANAGER – NHADA-WCT A common question we get here at NHADA — WCT is, “why is my injured worker get- ting bills for his workers’ comp injury” or “my employees’ treatment bills went to collections; why didn’t you pay them?" This is, unfortunately, an inquiry with a common denominator. They can’t bill us if they don’t know about us. Here are some tips to help avoid your employees getting bills for the treatment of their work-related injury: • Regular reminders, payroll stuffers, and signage: Making sure your employees know about NHADA and Managed Care before they are injured is key. The NHADA-WCT offers training on the process as well as posters and pamphlets explaining Managed Care and what to do when an employee is injured. Unfortunately, in many circumstances, the first the employees hear about workers comp is on the day of the injury, and they have so much to think about at that time, the information gets lost. • Don’t forget to call NHADA-WCT: At the time of an injury, if it’s not an emergency life or death situation, the injured worker and employer representative should call us. Speaking to the NHADA Nurse Case Manager or other WCT staff members will assist you through the process. During the call, we will have the opportunity to assist with the most appropriate in-network provider. At this time, we will also review what the injured worker should share with the pro- vider regarding billing. It is helpful for the employer contact to jot down our info and have the employee take it along when they seek treatment. • Immediately set up an occupational health visit: Be very wary of the employee who reports an injury and states, ”I am fine. I do not need to see a doctor." These situations frequently lead to unnecessary emergency room visits. The employee has no information about NHADA-WCT, and as a result, they get billed at home. If they go to an emergency room, there will be a facility charge, an emergency room physician charge and a radiology charge. Emergency rooms are notoriously slow at billing and it could be months before they start the billing process with the injured worker. Please speak to the employee and call NHADA-WCT to discuss an appropriate treatment option, if necessary, before the employee leaves for the day. We would rather pay for an occupational health visit the employee feels is unnecessary versus an unnecessary ER visit. • Preferred in-network provider versus out of network provider: Employees are all participants in the mandatory managed care network. This means that treatment outside of the network may not be covered. The NHADA-WCT team prides ourselves on the relationships we have built with occupa- tional specialists in New Hampshire; this brings highly specialized care to your injured employees. It also helps us as these providers “know us,” and they have all the employer/NHADA/billing informa- tion that is necessary to forward the billing for the treatment to us. When an injured worker presents to an out of network provider, such as a primary care provider or emergency room, they may be used to billing the employee’s healthcare provider and do so even if the visit is for a work-related injury. • Communication with front desk medical staff is key: When the injured worker presents for medical treatment, the few moments they spend with the front desk staff is crucial to the billing process. Checking in at the front desk is more than your name and the reason for your visit. Most receptionists will want to confirm your insurance. This leads to some confusion when presenting for a worker’s comp reason. The staff wants to see your health insurance card to make sure they have the most up-to-date information, but this sometimes masks the need to share “our” information. An injured worker must be upfront with the reception- ist as to the reason for the visit being worker’s comp, D R I V E 14