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Tip: Accident cases

Ambulatory Surgery Reimbursement Update, September 2, 2008

If a physician performs a surgery to treat an injury, find out as much information as you can on the front end about coverage.

What type of injury is it? Is it work-related or another type of accident? Obtain the necessary information in order to file the correct charges for reimbursement. This includes the following:

• Date of injury
• How the injury occurred
• Where the injury occurred
• The name and address of any liability or workers’ compensation carrier involved
• The name and address of any case manager and/or claims adjustor involved
• The claim number
• The patient’s employer name, address, phone number, and name of the person who handles workers’ compensation cases

Gather all of this information up front. There may be restrictions or additional steps the adjuster/carrier may require before surgery, and this can affect the scheduling. Be sure to allow enough time to obtain all of the various approvals needed on the front end, before the procedure occurs.

This tip is brought to you by Ellis Medical Consulting, Inc.

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