Do You Know the Rule? Ind. Medical Billing, Reports, Payment

Indianapolis, IN (WorkersCompensation.com) -- Billing is important business in the world of workers' compensation, especially when payment doesn't go exactly as planned. Here's a look at how the Hoosier State handles those situations.

If an Employer or Carrier doesn't Pay Bills

• If the employer or carrier directs the employee to a medical provider but does not pay all of the bills, the responsibility to resolve the dispute lies between the employer and carrier and the medical provider. 
• The insurance carrier cannot refuse liability for payment of a medical bill if the employer directed the employee to a medical provider for treatment.
• If the employee seeks reasonable medical care in an emergency or because of the employer's or carrier's failure to provide treatment, the bills may be the responsibility of the employer or carrier.

Medical Providers Attempting to Collect Money from Injured Workers

• If a medical provider is attempting to collect money from an injured worker, and the injured worker believes that the medical expenses should have been paid by the employer or carrier, the employee should immediately file a Request for Assistance and an Application for Adjustment of Claim with the Board. 
• The filing of the application may prevent the medical provider from collecting from the employee until a determination of liability for the bills is made.

Employees' Right to Obtain Medical Records

• The employee has the right to obtain medical records from any physician who has treated the employee under worker's compensation.
• If the physician has a reasonable charge for duplication of these records, the charge is the responsibility of the employee. 
• Physicians are required by law to provide records upon a signed, written request by the patient or the patient's representative. 
• A reasonable duplication charge may be made. Physicians must provide x-ray films at the physician's cost of duplicating the films.

Admissibility

To be admissible in proceedings before the Board, examination reports must be submitted to all parties 30 days in advance of a hearing. All medical statements prepared as part of an examination or evaluation of the employee must contain the:

• History of the injury, or claimed injury, as given by the patient
• Diagnosis of the physician or surgeon concerning the patient's physical or mental condition.
• Opinion of the physician or surgeon concerning the causal relationship, if any, between the injury and the patient's physical or mental condition, including the physician or surgeon's reasons for the opinion.
• Opinion of the physician or surgeon concerning whether the injury or claimed injury resulted in a disability or impairment and, if so, the extent thereof, and the reasons for the opinion.
• Original signature of the physician or surgeon.

New in '23 -- Clean Claims

Effective Jan. 1, a payor must pay or deny each clean claim not more than 30 days after the date the claim is received by the payor, if the claim is filed electronically or 45 days if the claim is filed on paper. The payor must notify a medical service provider of any deficiencies in a submitted claim not more than 30 days after the date the claim is received by the payor, for a claim that is filed electronically; or 45 days after the date the claim is received by the payor, for a claim that is filed on paper and describe any remedy necessary to establish a clean claim.

Failure of a payor to notify a medical service provider as required establishes the submitted claim as a clean claim.

If a payor fails to pay or deny a clean claim in the time required and the payor subsequently pays the claim; the payor shall pay the medical service provider that submitted the claim interest on the amount of the payor's pecuniary liability. Interest paid under subsection accrues beginning 31 days after the date the claim is received that was filed electronically or 46 days after the date the claim is received filed by paper. It stops accruing on the date the claim is paid. 

Stay up to date on Indiana and the rest of the country by subscribing to WorkCompResearch

Share This Article: