Many practices are so hungry for patients that they sign up on patient contracts that are not as much of a benefit as they should be. One of the contract types is Workers Compensation. Most doctors will see a work comp patient if they come into their office, but many practices and specialties actually look for these types of patients. But should YOU look for these patients? Do you know if your state is directed or non-directed? Does your state have a state mandated fee schedule or not? If so, what is the fee schedule? After extensive research HNA put together a work comp grid specifically to assist our doctors in making this decision. Keep in mind that if you are in a directed state, this means that an employer tells the employee what doctor they must go see for an injury. Whereas a non- directed state the employee chooses what doctor to go see. Of course a state mandated fee schedule is a fee schedule the state has produced as to the charges you will be reimbursed for these services. This seems easy enough but what to do with this information? Well, if you are contracting with a private carrier your fee schedule may be a cpt code fee schedule or a percentage of a mandated fee schedule.
Here's a little riddle?
Arizona is a non-Directed state with a state mandated work comp fee schedule
You live in Phoenix, AZ and you have been approached to contract with a work comp carrier for 70% of your billed charges OR 10% off the state mandated fee schedule if applicable whichever is less.
How do you do the math? Lets say the Arizona state mandated fee schedule pays $50 for an office visit and your office’s billed charges for this office visit is $60. What would your fee be?
70% of your billed charges is $42, and 10% off the fee schedule would equate to $45 dollars. So they will use the $42 reimbursement because it is lower.
OK, Riddle time: Should you contract with this carrier?
Probably not. Why? Because you are in a non-directed state and the patient was came to you because they wanted to see YOU not because they have to. You would have seen this patient if you weren’t contracted AND would have received $50 or %100 of the state fee schedule.
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