Whether hospitals outsource their workers’ compensation accounts to an outside vendor or handle them internally, there may be opportunities to recover additional revenue. Healthcare providers oftentimes write off entire accounts or settle for reimbursements which are less than they are entitled to receive. Using a workers’ compensation attorney can protect a healthcare provider’s right to be paid at a higher rate or its right to be paid at all where the patient is being represented by an attorney.
At Audley Law Offices, P.C., the most common missed revenue opportunities we see pertaining to Pennsylvania Workers’ Compensation are:
The Fee Review Process is complicated and has strictly enforced deadlines. Failing to file the initial administrative review on time or in the correct format, or failing to seek timely review before a Workers’ Compensation Judge, will result in a denial. Carriers will often make promises to pay or claim that payment is “in process.” If this delays the filing of an application for fee review beyond the statutory deadline, any opportunity to challenge the payment decision is lost. Failing to timely challenge such a denial with a request for a hearing before a Workers’ Compensation Judge can also forfeit the right to additional payment. This is particularly important if the hospital is a trauma center or a burn unit as they may be entitled to significant additional payment if the care is for life threatening or urgent injuries or for serious burns. Carriers will nearly always make a fee schedule payments. If unchallenged, these improper payments can mean millions of dollars in lost revenue to hospitals with busy trauma centers or burn units.
At Audley Law Offices, we have recovered millions of dollars for hospitals on accounts that would have otherwise been written off had timely fee reviews not been filed or had we not sought relief before a workers’ compensation judge. Hospitals and insurance carriers must be represented by an attorney when the matter proceeds before a judge. We have handled dozens of fee review hearings and prevailed in nearly all.
THIRD PARTY LIABILITY
When a carrier denies payment, claiming that they are either not liable for the underlying injury or that the care provided was not related to the injury, hospitals mistakenly believe that they have no recourse. Unless there is available health insurance, the balance is written off or charitable assistance is offered to the patient.
However, hospitals do have recourse. Our office has successfully worked with carriers to reverse such denials by presenting them with medical records and effective arguing that their denial was in error. Once the carrier accepts responsibility, our clients receive a “medical only” notice allowing payment for the medical expense but avoids the hospital admitting responsibility for other benefits.
Other times, when carriers maintain their denial, we have been able to convince the patient to pursue the claim themselves. Although some patients are reluctant to assist in seeking payment from their employer, that reluctance often fades when they are advised by an attorney that if the bill is not paid, they will have to pay it. Many patients are under the misconception that hospitals are not permitted to seek payment directly from them. We explain that they can be made to pay the expenses but offer to assist them in pursing the claim, either directly or through a referral to a workers’ compensation attorney. Our attorneys have represented claimants in workers’ compensation matters for over twenty years.
Hospitals that are owed for care provided to an injured worker are not required to be notified when a patient and workers’ compensation carrier enter into a settlement of the claim. As these settlements can include the patient releasing the carrier for liability for medical expenses, such settlements can result in no payment to the hospital. Attorneys will often use the amount of unpaid medical expenses as leverage to secure the largest amount possible for the patient and then not make provisions for payment of those same expenses from the settlement amount. In these matters, we protect the hospitals we represent by promptly contacting all parties involved and by requiring that the patient and their attorney agree to address the outstanding hospital bills in any settlement. This is accomplished through the use of forbearance agreements which provide that the hospital will forgo it right to seek immediate payment of the medical expenses, in Court, if necessary, in exchange for the promise that the medical expenses are paid as part of any settlement.