Common Objections to Workers’ Comp Reports: Prior Injuries

This article is part of a series on the top reasons why insurance carriers object to a workers’ compensation report and return it to the medical practice unpaid. This article is intended for medical providers, administrative staff, office managers, as well as insurance claims adjusters.

We have now covered two reasons that an insurance claims adjuster may object to your impairment PR-4 report: First, due to an incomplete history of symptoms, and second, because of an incomplete activities of daily living (ADLs).

It is the intention of the claims adjuster to be skeptical about any and all things that can set off red flags in the review process of your reports. Should they find any documentation regarding a previous claim, the insurance company will go through the worker’s history of injuries in the workplace with a fine tooth comb to ensure that the current injury is not a result of symptoms of a prior injury.

Reason #3: Prior Injuries

If an employee gets hurt at work, the patient’s previous medical history may be relevant to the claim.

 

For example, imagine that someone has had back pain for a long time due to a childhood injury. Then she gets a job. One day while at work, she falls off a ladder and hurts her back even more.

The physician’s work comp report should include information not just about the current injury—the falling off the ladder incident—but also about the previous injury.

Why?

Well, the patient has symptoms—back pain, inability to sit for long periods of time, difficulty dressing—but it’s possible that some or all of these symptoms existed before the work-related injury. The question becomes—which symptoms were caused by the work-related injury? Which symptoms existed previously, but are now worse due to the work-injury?

These questions are all oriented around the one central question: what was the patient’s life like prior to the injury?

When it comes time to write the impairment report and calculate the impairment rating for the injury, information about all previous conditions will be critical for calculating apportionment—but that’s a different story.

For now, the important thing to remember is that the history of any injuries affecting a body part that has been injured at work should be included in workers’ comp reports. If the claim’s adjuster is reviewing a report on an employee’s spine injury, and the adjuster knows that the patient’s spine had been previously injured but doesn’t see any information about that prior injury in the report, it will raise a question: how much of the symptoms are caused by the work injury?

The goal is to answer that question before the adjuster can ask it. This way, there will be no reason for the insurance carrier to deem your report incomplete.

Note that the prior injury is only applicable to the specific body part injured in the current impairment report, e.g., a prior injury to the left arm is not applicable to an injury in the right leg.

In your workers’ comp report, include a section for each prior injury that is relevant to the claim. In RateFast, information about prior injuries is automatically presented under a “Medical History” heading, and organized by each body part. Information should include how any prior injuries affected the patient’s ADLs, whether there was surgery, medications currently being taken for the prior injury, and so forth.

Here’s an example of a decent description of a prior injury:

Employee reports that her cervical spine was injured in a car accident when she was 12 years old. Symptoms included limited mobility (range of motion unknown) and pain. Prior to work-injury, took 300 mg ibuprofen daily. ADLs impacted: sleeping (caused patient to wake up) and driving (difficulty turning neck).

Here’s a poor description of a prior injury that is likely to raise questions in the insurance adjuster’s mind:

Employee reports that her cervical spine was injured.

But the worst description of all is no description. Always ask about prior injuries, and take detailed notes.

In Conclusion

In an impairment report, the description of prior injuries should be like a miniature report in-and-of itself. The physician must work with what he/she has in order to ensure that the prior injuries are thoroughly and accurately described. It may be difficult to obtain a detailed record of an injury from many years ago, but if the information about prior injuries doesn’t satisfy the claim’s adjuster, then the report may be returned—unpaid and with questions.

How to Make a Correction or Add an Addendum to a RateFast Report

This post is for RateFast users who want to make a correction, fix a typo, or add additional content to a RateFast report that has been closed and signed.

Picture this: a provider has reviewed and signed the RateFast report. The report is now closed and can no longer be edited.

But wait. There’s a typo.

Continue reading How to Make a Correction or Add an Addendum to a RateFast Report

Common Objections to Workers’ Comp Reports: Incomplete Activities of Daily Living (ADLs)

This article is part of a series on the top reasons why insurance carriers object to a workers’ compensation report and return it to the medical practice unpaid. This article is intended for medical providers, administrative staff, office managers, as well as insurance claims adjusters.

In our previous post of this series, we discussed the history of symptoms in the doctor’s impairment PR-4 report. The following section covers the next step in the subjective complaints category.

You are facing the possibility that your report could be returned, possibly for the second time, and it is very important to you and your patient that you cross your t’s and dot your i’s so that you make this as timely of a process as possible. Like anything else, taking a few moments to take extra care can save your hours or even days of trouble in the future.

Continue reading Common Objections to Workers’ Comp Reports: Incomplete Activities of Daily Living (ADLs)

Common Objections to Workers’ Comp Reports: Incomplete History of Symptoms

This article is part of a series on the top reasons why insurance carriers object to a workers’ compensation report and return it to the medical practice unpaid. This article is intended for medical providers, administrative staff, office managers, as well as insurance claims adjusters.

You’re at the clinic and you receive a fax or a letter from an insurance carrier related to an impairment PR-4 visit with a workers’ comp patient

Payment for the visit? Not quite.

Continue reading Common Objections to Workers’ Comp Reports: Incomplete History of Symptoms

Automation Is Coming to Workers’ Compensation: Could Your Job Be Done by a Robot?

“We are coming closer to the point where not only cashiers but surgeons might be at least partially replaced by A.I.,” said former Federal Reserve Chairman Ben Bernanke in a recent interview.

The rapid integration of automation in all industries is undeniable. The surprising news is that there are many jobs that have traditionally required an expert—a highly trained human professional—that can be better performed by robots, at least in part.

Workers’ compensation is no exception. As the sun sets on the age of the expert and rises on the age of the machine, workman’s comp is a critical example of a field that will benefit from automation.

Continue reading Automation Is Coming to Workers’ Compensation: Could Your Job Be Done by a Robot?

Top 5 Articles of 2016

From how to use an inclinometer correctly to understanding why a panel QME gets involved in a work injury, read up on the best workers’ compensation content of the past year.

  1. What’s A QME?
  2. Muscle Atrophy
  3.  Exacerbation vs. Aggravation
  4. Activities of Daily Living
  5. How to use an Inclinometer

Do you have a workers’ compensation topic you’d like to see covered? Email us and we’ll put our best people on it!

Automated Impairment Rating: The Science Behind RateFast

RateFast automates the impairment rating process, giving providers and injured workers the ability to generate accurate analyses of occupational injuries based on the AMA Guides to Impairment Rating.

But how is it done?

Listen to the podcast or keep reading to discover how CPA Josh Moore applies knowledge from accounting to the development of the RateFast impairment rating system.

Continue reading Automated Impairment Rating: The Science Behind RateFast

Playing the Game of Chicken in Workers’ Comp

The price that grocery stores pay for chicken is based on a particular index. This Washington Post article reveals how our entire nation agrees to pay the price of chicken based on this index. The newsworthy claim of the article is that if we really look at the open market, the stores are paying a price for chicken that is completely arbitrary, rather than the correct or natural price of chicken.

This is problematic not only for the consumer but for the industry as a whole.

As fascinating as this is, why are we discussing this on our workers’ compensation blog? What are the implications of this concept for work comp in California? Read on to find out.

chicken

Chicken” by Thomas Vlerick is licensed under CC BY 2.0

Continue reading Playing the Game of Chicken in Workers’ Comp

NueMD ICD-10 Code Lookup Tool

If part of your workflow involves looking up ICD-10 codes, you should check out NueMD’s ICD-10 Code Lookup tool.

This might be old news if you’re in the coding business, as the website is actually ranked #1 in Google’s search results when you search “icd-10 code lookup tool.”

It’s easy to see why. NueMD’s code lookup tool sports a clean interface and modern features that are geared toward engaging and keeping users.

When you create a free account, you can save your favorite codes in your own personal categories.

NueMD ICD-10

Other bells and whistles that are not often featured on other web-based coding tools include training in the form of several coding games, and the ability to search for common codes by your specialty—dermatology, infectious disease, podiatry, and others.

NueMD allows you to find codes by common abbreviations and keywords, giving it clear leg up when compared with one-way code search sites such as www.icd10codesearch.com/. NueMD’s site is also less cluttered and less spammy than other tools like www.findacode.com.

The actual content about each code seems comparable to the code information provided by other services. I’m not a professional biller, but I didn’t notice any significant differences between NueMD and www.icd10data.com for the codes that I searched. However, NueMD has clearly put effort into making their tool stand out.

Conclusion

If you ever need to lookup codes online, NueMD’s app is worth a whirl. It has features and design-values that billers and other professionals in medicine should demand from their software.

Have you used NueMD’s ICD-10 code search tool? What was your experience? Do you have a different favorite tool for looking up codes? Let us know. Contact us by email or on social media.