Workers comp claims

[Guest guest]

Hey , give me a call, it's complicated...

See ya,

F. E.

Cell

Ofc

“The fate of the wounded lays with those who apply the first dressing.†—

Col. Senn, 1844-1908. 49th President, American Medical

Association-1897

[Guest guest]

This question is for all billing and claims processing people. I am in need of

factual information with a resource reference if available. I have a strong

opinion, as I am sure many will have, but I truly need comments that can be

supported with some sort of documentation .... so here is the story

EMS responds to a 911 request for ambulance services. The call results in the

transport of a patient from a work related incident. The patient is transported

to the ED.

A company official advises that the bill is to be mailed to their office where

it will then be submitted to the workers comp ins company for payment of EMS

services. The bill is sent at 30, 60, and 90 days and goes unpaid. At 180 days,

the company faxes you a copy of the workers comp ins info (which they would not

provide earlier) and ask that you file the claim. Since comp claims have to be

filed in under 90 days, the claim is denied, the company refuses to pay and the

employee has moved away.

1. Is the company liable for the bill since information was not provided to

the EMS firm in a timely manner?

2. Can the patient be held responsible for the bill?

3. Does the EMS firm have any resource to obtain workers comp information

when not provided by the company upon request?

4. Is the EMS firm prevented by law from pursuing the company or patient for

payment of the bill since ins. information was not provided in a timely manner?

I have worn the internet out looking for an answer. If anyone can point me in

the right direction, it is appreciated.

, Director

Seminole EMS

[Guest guest]

,

I would contact your local office of the Texas Department of Insurance -

Division of Workers Compensation for assistance. It is in fact against

the law to bill the patient under the Texas Law - however the company

should forward the claim to the carrier in a timely manner. If you

would contact me by telephone I may be able to help you further....

Les

Les

NREMT-Paramedic, HM-M, CSST, SAPA, RSO, AHA-TCF

Senior Safety Coordinator / Emergency Response Coordinator

Westlake Chemical

P.O. Box 228

36045 Highway 30

Geismar, LA 70734-0228

e-Mail: lpowell@...

Telephone:

Fax:

Cell: 225.439-6552

Captain - Ascension Parish Fire District 1 - Staion 70 -

http://www.apfire.us/ e-Mail: FD707@...

%20FD707@...>

Industrial Fire World Advisory Board - Industrial Fire World

http://www.fireworld.com/>

Secretary - Geismar Area Mutual Aid Association (GAMA) -

http:www.gamaid.org

Affiliate Advisory Council - Texas: National Association of Emergency

Medical Technicians http://www.naemt.org/>

Board of Directors - Emergency Medical Services Association of Texas

(EMSAT) http://www.texasemsat.org/>

The information transmitted (including attachments) is covered by the

Electronic Communications Privacy Act, 18 U.S.C. 2510-2521, is intended

only for the person(s) or entity/entities to which it is addressed and

may contain confidential and/or privileged material. Any review,

retransmission, dissemination or other use of, or taking of any action

in reliance upon, this information by persons or entities other than the

intended recipient(s) is prohibited. If you received this in error,

please contact the sender and delete the material from any computer,

disk drive, diskette, or other storage device or media.

" Next to creating a life, the finest thing a man can do is save one. " -

Abraham Lincoln

SAVE THE DATE!

Industrial Fire World Emergency Responder Conference & Expo

Crowne Plaza Hotel - Baton Rouge, LA

22-26 February 2010

________________________________

From: texasems-l [mailto:texasems-l ] On

Behalf Of

Sent: Wednesday, August 26, 2009 15:40

To: texasems-l

Subject: Workers comp claims

This question is for all billing and claims processing people. I am in

need of factual information with a resource reference if available. I

have a strong opinion, as I am sure many will have, but I truly need

comments that can be supported with some sort of documentation .... so

here is the story

EMS responds to a 911 request for ambulance services. The call results

in the transport of a patient from a work related incident. The patient

is transported to the ED.

A company official advises that the bill is to be mailed to their office

where it will then be submitted to the workers comp ins company for

payment of EMS services. The bill is sent at 30, 60, and 90 days and

goes unpaid. At 180 days, the company faxes you a copy of the workers

comp ins info (which they would not provide earlier) and ask that you

file the claim. Since comp claims have to be filed in under 90 days, the

claim is denied, the company refuses to pay and the employee has moved

away.

1. Is the company liable for the bill since information was not provided

to the EMS firm in a timely manner?

2. Can the patient be held responsible for the bill?

3. Does the EMS firm have any resource to obtain workers comp

information when not provided by the company upon request?

4. Is the EMS firm prevented by law from pursuing the company or patient

for payment of the bill since ins. information was not provided in a

timely manner?

I have worn the internet out looking for an answer. If anyone can point

me in the right direction, it is appreciated.

, Director

Seminole EMS

[Guest guest]

No reference guide facts, but we send the patient the bill and he is

responsible for get WC payment to himself, or us within 90 days.

Andy Foote

Workers comp claims

This question is for all billing and claims processing people. I am in

need of

factual information with a resource reference if available. I have a

strong

opinion, as I am sure many will have, but I truly need comments that

can be

supported with some sort of documentation .... so here is the story

EMS responds to a 911 request for ambulance services. The call results

in the

transport of a patient from a work related incident. The patient is

transported

to the ED.

A company official advises that the bill is to be mailed to their

office where

it will then be submitted to the workers comp ins company for payment

of EMS

services. The bill is sent at 30, 60, and 90 days and goes unpaid. At

180 days,

the company faxes you a copy of the workers comp ins info (which they

would not

provide earlier) and ask that you file the claim. Since comp claims

have to be

filed in under 90 days, the claim is denied, the company refuses to pay

and the

employee has moved away.

1. Is the company liable for the bill since information was not

provided to

the EMS firm in a timely manner?

2. Can the patient be held responsible for the bill?

3. Does the EMS firm have any resource to obtain workers comp

information

when not provided by the company upon request?

4. Is the EMS firm prevented by law from pursuing the company or

patient for

payment of the bill since ins. information was not provided in a timely

manner?

I have worn the internet out looking for an answer. If anyone can point

me in

the right direction, it is appreciated.

, Director

Seminole EMS

[Guest guest]

First - it is against Texas Law to send a bill an injured employee... I know of

several folks that received some pretty stiff fine for billing " patients " - and

it was not the companies that get fined - TDI - DWC fines individuals...

TITLE 28

http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=2&ti=28> PART

2

http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=3&ti=28&pt=2>

CHAPTER 133

http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=4&ti=28&pt=2&c\

h=133> SUBCHAPTER B

http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=5&ti=28&pt=2&c\

h=133&sch=B&rl=Y> RULE §133.20

(k) A health care provider shall not submit a medical bill to an injured

employee for all or part of the charge for any of the health care provided,

except as an informational copy clearly indicated on the bill, or in accordance

with subsection (l) of this section. The information copy shall not request

payment.

(l) The health care provider may only submit a bill for payment to the injured

employee in accordance with:

(1) Labor Code §413.042;

(2) Insurance Code §1305.451; or

(3) §134.504 of this title (relating to Pharmaceutical Expenses Incurred by

the Injured Employee).

The link below will should help with the appeal the claim denial....

http://www.tdi.state.tx.us/wc/hcprovider/documents/provider95bill.pdf

Les

NREMT-Paramedic, HM-M, CSST, SAPA, RSO, AHA-TCF

Senior Safety Coordinator / Emergency Response Coordinator

Westlake Chemical

P.O. Box 228

36045 Highway 30

Geismar, LA 70734-0228

e-Mail: lpowell@...

Telephone:

Fax:

Cell: 225.439-6552

Captain - Ascension Parish Fire District 1 - Staion 70 - http://www.apfire.us/

e-Mail: FD707@... %20FD707@...>

Industrial Fire World Advisory Board - Industrial Fire World

http://www.fireworld.com/>

Secretary - Geismar Area Mutual Aid Association (GAMA) - http:www.gamaid.org

Affiliate Advisory Council - Texas: National Association of Emergency Medical

Technicians http://www.naemt.org/>

Board of Directors - Emergency Medical Services Association of Texas (EMSAT)

http://www.texasemsat.org/>

The information transmitted (including attachments) is covered by the Electronic

Communications Privacy Act, 18 U.S.C. 2510-2521, is intended only for the

person(s) or entity/entities to which it is addressed and may contain

confidential and/or privileged material. Any review, retransmission,

dissemination or other use of, or taking of any action in reliance upon, this

information by persons or entities other than the intended recipient(s) is

prohibited. If you received this in error, please contact the sender and delete

the material from any computer, disk drive, diskette, or other storage device or

media.

" Next to creating a life, the finest thing a man can do is save one. " - Abraham

Lincoln

SAVE THE DATE!

Industrial Fire World Emergency Responder Conference & Expo

Crowne Plaza Hotel - Baton Rouge, LA

22-26 February 2010

________________________________

From: texasems-l [mailto:texasems-l ] On Behalf

Of rachfoote@...

Sent: Wednesday, August 26, 2009 16:00

To: texasems-l

Subject: Re: Workers comp claims

No reference guide facts, but we send the patient the bill and he is

responsible for get WC payment to himself, or us within 90 days.

Andy Foote

Workers comp claims

This question is for all billing and claims processing people. I am in

need of

factual information with a resource reference if available. I have a

strong

opinion, as I am sure many will have, but I truly need comments that

can be

supported with some sort of documentation .... so here is the story

EMS responds to a 911 request for ambulance services. The call results

in the

transport of a patient from a work related incident. The patient is

transported

to the ED.

A company official advises that the bill is to be mailed to their

office where

it will then be submitted to the workers comp ins company for payment

of EMS

services. The bill is sent at 30, 60, and 90 days and goes unpaid. At

180 days,

the company faxes you a copy of the workers comp ins info (which they

would not

provide earlier) and ask that you file the claim. Since comp claims

have to be

filed in under 90 days, the claim is denied, the company refuses to pay

and the

employee has moved away.

1. Is the company liable for the bill since information was not

provided to

the EMS firm in a timely manner?

2. Can the patient be held responsible for the bill?

3. Does the EMS firm have any resource to obtain workers comp

information

when not provided by the company upon request?

4. Is the EMS firm prevented by law from pursuing the company or

patient for

payment of the bill since ins. information was not provided in a timely

manner?

I have worn the internet out looking for an answer. If anyone can point

me in

the right direction, it is appreciated.

, Director

Seminole EMS