Some question's presented to "The Expert" may warrant a response to offer further information regarding certain rules, regulations and/or other topic's and information (including this website)! Submit a question to "The Expert", and your question along with a expert response may appear on this page! Have a question? Let "The Expert" respond!
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On November 13, 2003 from Los Angeles, California. "Are Workers' Comp rules the same for the Private Industry, and the Postal Service?"
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Expert:
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No, The US Postal Service Workers' Comp rules are regulated by the US Government Office of Personnel Management (OPM), and U.S. Dept. of Labor (DOL), Employment Standards Administration (ESA), and Office of Workers' Compensation Programs (OWCP)
while private industry employer's rules are agency regulated on a "state by state" basis.
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What if I don't want to give my credit card over the Internet?
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Expert:
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No problem! Simply continue through the ordering process until it asks you for a credit card number, then simply choose "phone" as a payment option and we will receive your order electronically. You can then give us your credit card number over the phone, or make some other payment arrangement, and as soon as we receive payment, your request will be completed.
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On November 19, 2003 from San Bernardino County, California. "What does workman's comp reimburse for OT services?"
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Expert:
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"The Current Procedural Terminology (CPT) billing and reimbursement code range for the Occupational Therapist specialty is "97010 - 98778", in which some codes have a set reimbursement rate, and some codes do not have a reimbursement rate depending on which services are rendered and billed."
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On April 20, 2004 from California. "How do you think the most recent legislation will play out here in CA?"
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Expert:
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SB 899 (Poochigian) is "underdeveloped" as it relates to some of the new initiatives. Therefore, it will take more time (duration unknown) to fully complete the initiatives as they currently exist.
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On June 3, 2004 from Los Angeles, California. "What are the laws regarding what to do with workers' compensation patient files after they have been billed? Who is responsible for the patient files? I am cleaning out my husband's medical office and there was a billing person doing workers' comp. billing there. This person left about 200 patient files behind and will not return my calls to remove these files. What do I do with them? I have called CA workers' comp, HIPAA and Consumer Affairs. HELP!"
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Expert:
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All patient medical information are "legal" documents. Therefore, you need to retain all medical information (including billings) based on "statute" requirements in case any litigation ever arises. If the 200 files you mentioned are regarding patients who are no longer in treatment, then you will need to develop a "storage system" for those files. Outside storage companies such as "Public Storage" is just one example. After statutes have expired, then you could "destroy" the medical information. There are "destruction" companies that now exist who can come out to the medical practice and do this (shred the information) once the statute requiremet has expired. However, they do charge a fee for this service.
Please visit the California Medical Association website for starters to learn the statutes regarding the retention of medical records. Below is a link to help you get started! Hope this works out for you. Good Luck!
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On July 6, 2004 from Inglewood,CA: "How do you think the CPC would be valuable to the Workers' Comp Industry?"
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Expert:
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The Certified Professional Coder (CPC) certification would be valuable for anyone who may be interested in "coding" and/or "billing" workers' compensation claims. Various state legislation and/or reform may begin to require the Certified Professional Coder (CPC) certification as it relates to accurate "coding" and "billing" of both the CPT and ICD-9 codes as they "specifically" relate to the processing of workers' compensation claims, as well as other types of medical claims across the nation.
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On February 23, 2005 from South Carolina: I am interested in medical claim auditing. Particularly inpatient hospital claims. How would one be able to obtain pertinent informaiton from patients like copies of bills and medical records from the hospitals when they are not allowed to give them out, but only to the patient? In addition, will I be able to keep this informaiton at my home or does it have to be in a storage area like a housing warehouse? Please advise.
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Expert:
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Your interest in medical claim auditing is great! You indicated that you are specifically interested in auditing inpatient hospital claims. You posed a question regarding obtaining "pertinent information" from patients such as copies of medical bills and medical records, and a question regarding the retention of this kind of information.
If you plan is to develop a home business for medical claim auditing, you must consider who your customer is! The healthcare provider, patient, and/or insurance company. Once you decide who your customer will be, this will lead you to the obtaining of the relevant medical documentation (encounter forms, bills, medical records). You indicated that your interest is for hospital claims. You must decide who you will be conducting audits for, and what the purpose will be for the audit (medical necessity, excessive charges, denied charges, etc...), and the type of claim to be audited (medicare, worker's comp, group health, etc...).
Medical record retention is "required" based on individual state regulations, and is mostly dictated to hospitals and physicians. Review the South Carolina medical retention laws to gain more insight regarding who, and how long medical documention is to be maintained. Depending on who (physician, patient, insurance company, etc...)they will need to "voluntarily" provide you with the medical documentation to conduct an audit, and based upon an agreement between you and your client, the medical documentation could possibly be returned to the client, or you may want to retain a copy of relevant information used to conduct and justify decisions made regarding the outcome of the audit.
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