The purpose of workers’ compensation is to ensure that an employee receives wages and medical treatment in the event that he or she is unable to work, following an on-the-job injury or if the employee requires medical attention due to a disease incurred as a result of his or her employment.
Almost 3 million of these injuries were reported by private employers in 2017, according to the US Department of Labor.
Following an on-the-job injury that requires physical therapy (PT), it only makes sense to work with a physical therapy group that understands the ins and outs of workers’ compensation. That is, they should be familiar with the relevant workers’ comp rules and regulations, including employer and worker responsibilities, what tests and therapies are covered and for how long.
Streamlining the Workers’ Compensation Process
After selecting a PT group experienced in treating patients with workers’ comp injuries, there are several ways they will be able to streamline the process for you.
Prior to arriving for your first physical therapy appointment, the PT office will have confirmed your workers’ comp eligibility. This ensures your personal health insurance isn’t billed or that you become personally responsible for out-of-pocket expenses. Getting this sorted out initially is important – and is an added stress an injured employee doesn’t need. It is much more important to focus on the therapy and getting better.
In addition, the PT group will proactively bill workers’ compensation and provide proof of authorization to you. The group will also track the number of therapy visits as allowed by your specific workers’ comp benefits. Therapy visits must correlate with the conditions set forth in the authorization paperwork. If not, the claim will be denied. If the patient has a separate medical condition that isn’t related to the on-the-job injury, it isn’t permitted to be included as part of the treatment. The patient’s private insurance will be billed separately, or the patient will be responsible to pay for the treatment.
Once a diagnosis is made, the physical therapy group is responsible for reporting it to the workers’ compensation carriers. If the specific, approved diagnosis goes unreported, the therapy will be denied. Workers’ comp providers require documentation for each treatment performed.
The physical therapy group will explain the fee schedule as it relates to the workers’ compensation payments. The payment schedule will coincide with an approved fee schedule that is sanctioned by the state in which the patient is being treated.
Rehabilitation is part of Endeavor Physical Therapy & Wellness of Austin, Texas, which offers tailored physical therapy for its workers’ compensation patients. For more information, please call (512) 284-7192.
The factors considered include: industrial classification, risk and the experience rating.