RE: Digest 278, Work Comp

[Guest guest]

First, Barrett Dorko is correct in stating that we should not prejudge

patients based on their insurance status. We cannot assume that work comp

referrals are malingerers any more than we can assume that patients with

disability insurance are faking their disability.

I also agree with Shari son's message with one exception: The employer

is not paying the patient's medical bill, worker's compensation is an

insurance program. The employer pays for insurance, rated for different

occupational categories based on risk. These patients do not need to be

singled out or treated any differently than any other type of patient, as

with different insurance programs, we sometimes have to communicate more

with case managers or fill out some particular forms, (hoops we jump through

to be paid). If secondary therapy diagnoses are discovered, a prescription

and pre-approval must be acquired.

I have often wondered whether it is even within the therapist's scope to

discern between real and contrived complaints by patients. If all patients

are treated as if they are honest, and objective methods are used, then

essentially the documentation should speak for itself. In other words,

professional opinions are based upon facts, not preconceived notions.

As for remuneration, if communication is kept open with docotrs and case

managers and services are pre-approved, payment is not a problem. However,

there are certainly different rules and fee schedules in each state. For

example, in Georgia we are paid by CPT code; in Montana the payment is a per

visit rate no matter what treatment is required. Here in Georgia, our clinic

has no problem with work comp accounts receivable, in fact it is one of the

best payers. The only complaint we have is that the payment cannot be

considered late until after 45 days. At any rate, it pays better than

Medicare and is usually on time.

Caren , PTA

Message: 7

Date: Thu, 28 Dec 2000 10:17:40 -0600

Subject: RE: Workman's Comp

The Outpatient Practice that I manage includes a significant portion of

work comp. cases for PT/OT and Industrial Rehab (100% Work Comp.).

Treatments become complex because the employer is who is paying the bill

- but the patient is who we are working for. Keeping a positive and

open opinion is crucial. A small percent of our patients are " working

the system " or being coached by attorneys. Working with the patient and

employer to get the patient taken care of and back to work is obviously

the goal. It is important that your therapists understand your State's

Work Comp system. It is generally more financially beneficial for

employees to return to their job. The thought of making lots of money

on work injuries is (in most states) not a reality.

Issues we have learned from experience include - despite our professions

stand on treating the whole patient, you will find that if the work

injury report states the patient injured his shoulder - the work comp

provider will generally not authorize treatment for any other area of

the body. This means if you find in your evaluation involvement of the

neck, the employer and work comp carrier will be contacting you promptly

if you start adding " injured " parts to the claim. My suggestion is to

work closely with the referring Physician. Many case managers,

employers, insurance carriers don't understand the concept of the neck

and shoulder (hip/knee, etc) having any kind of connection. Working

with employers to obtain job descriptions that include the physical

demands of the job really help in return to work issues. This is also a

very complex thing to do and requires experience and diplomacy. Hope

that helps. As an Outpatient Therapist, I have enjoyed working with

this group of patients. We have had many patients with devastating

injuries that want to return to work. It's not as bad as some make it

out to be.

Shari son, Outpatient Rehab. Manager-Mulvane Clinic, St. Francis

Hospital and Medical Center - Topeka, KS

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