First, we’ll start with the bigger question: Why should I get my clinic started with workers’ comp?
Revenue and reputation, that’s why.
Workers’ compensation can be profitable for your clinic, and boost your reputation. For the clinic that aspires to something greater, this is the guide for you.
But before you open your doors to doing workers’ compensation, be aware that there are several hurdles to overcome for you and your business.
The Steps, At a Glance
By following the steps below, you can get started as a workers’ comp clinic.
- Determine that your clinic is the right type of clinic to begin a workers’ comp practice.
- Hire a manager (separate from the one who already works at your clinic) who is comfortable with case management.
- Determine if hiring additional staff is required.
- Join MPNs (Medical Provider Networks) to begin receiving patients who were injured at work.
- Train your staff on your state’s workers’ compensation laws and practices.
The Best Type of Clinic for Workers’ Comp
Urgent care clinics will have a higher likelihood of success getting started in workers’ comp than say, family practices or emergency rooms.
Urgent care clinics are better equipped with supplies and staff than a family practice, while not having the level of critical immediacy that an emergency room has. The pressure on the staff of an emergency room is too unpredictable for a series of scheduled workers’ comp meetings.
During the year, an urgent care clinic sees feast or famine. The busy season comes in the winter months, when patients multiply because they’re getting colds and the flu. The rest of the year, business can be very hit-or-miss. As with any business, lack of customers means a lack of revenue.
However, urgent care centers who take work comp patients aren’t as likely to see a shortage of business, even during slow months, for two reasons:
A: People get hurt at work all year round, and
B: Few clinics practice workers’ comp
Why do so few clinics practices work comp?
We’ll be honest: it isn’t necessarily the easiest business to get into.
What it Takes to Get Started
Workers’ compensation is perfect for the clinic who aspires to expand, because your clinic needs to carve out an entirely new department dedicated to workers’ compensation.
Understand that it’s not just an urgent care clinic anymore: your clinic is now also a case management clinic.
In order to run a case management clinic, you need to equip yourself with a staff of case managers: organized and dilligent individuals who will move work comp claims forward.
You will most likely have to hire a separate office manager to handle workers’ comp.
Your current office manager who is trained to handle your patients and their information will not have the time or the energy to handle the workload of workers’ compensation claims by themselves.
Understand that with claims, the involved parties are not simply the patient and the doctor. Your new, workers’ comp office manager must oversee communications between you, the injured worker, their employer, their insurance adjusters, as well as additional stakeholders such as QMEs and attorneys.
In complicated cases, your work comp managers must be comfortable referencing and contacting the DWC, the DIR, and more.
Additional staff may be required to handle the workload of multiple claims, as there are so many stakeholders involved with any single claim.
Joining MPNs (Medical Provider Networks)
Every workers’ compensation insurance carrier subscribes to a specific MPN.
Injured workers are able to choose their PTP (Primary Treating Physician) from a list of clinics on the MPN associated with their employer’s insurance company.
So, a doctor cannot take on a patient’s work comp claim if they are not part of the employer’s MPN. Therefore, a doctor must be part of an MPN in order to handle patients for workers’ compensation.
In order for a clinic to maximize the number of patients that they receive, they will want to join as many MPNs as possible.
Once the right administrative staff has been hired, a bit of their attention should be focused on communicating with MPNs and joining new networks.
Understanding the Reports
According to RateFast’s data, the average workers’ comp claim lasts around 18 months. Much of the time, the claim outlives the amount of time the injury takes to heal (or to improve as much as it’s going to–see our article on Maximum Medical Improvement).
Many states have a system of reports that the physician handling the claim must create. These reports detail the beginning, middle (progress), and end of a claim.
In California, the three classes of reports are the Doctor’s First Report (5021), the Physician’s Progress Report (PR-2), and the Permanent & Stationary Report (PR-4).
Even if you are not in California, you will still be required to write visit notes that contain similar information to these California reports.
- The Doctor’s First Report is the initial report of the injury for the claim. The Doctor’s First Report is written by the PTP assigned to the claim.
- The provider must write a PR-2 progress report for every follow-up visit. The PR-2 addresses the progress of the injury, and includes measurements of the injured body parts’ improvement, and addresses the efficacy of treatments.
- The PR-4 report is the bulkiest of the reports. The PR-4 report finalizes the claim. It is written when the patient reaches MMI (Maximum Medical Improvement), and informs the insurance carrier and other stakeholders whether or not their work injury has led to permanent impairment. The calculations to measure the degree of permanent impairment is based on the AMA Guides 5th edition in California. (Other states use other versions of the Guides, or their own rule sets).
Writing complete reports and determining an accurate impairment rating is important. The claim’s insurance adjuster will refuse any reports that have inconsistencies or inaccuracies. This will drag the claim out longer, which is rarely good for anybody. To prevent drawn-out claims, your providers and office managers should have a system in place for writing consistent, complete workers’ compensation reports.
Impairment Rating Software Helps Speed Things Up Exponentially
Remember, each workers’ compensation patient requires an impairment rating.
While the California Department of Industrial Relations provides a form for the Permanent & Stationary PR-4 report, the impairment report requires knowledge of the laws. This is part of what makes the workers’ compensation system complicated and challenging.
If you’re a new clinic getting started with workers’ compensation, you need to decide how you will calculate your patients’ impairment ratings. There are a few options:
- In-House Ratings: One of your providers will calculate the impairment ratings for your patients. This option is excellent for physicians who have an active interest in workers’ compensation and are knowledgeable in the AMA Guides (or other impairment rating guidelines).
- Impairment Rating Software: Rather than your physician’s spending their time calculating ratings, you can enter your patient’s injury information into software such as RateFast, and then receive an impairment rating. This is a good option for clinics with providers who are not necessarily experts in impairment ratings, or who would rather spend their time elsewhere. You can join RateFast for free, or search for other impairment rating software solutions.
Ultimately, opening your door to injured workers is a serious, long-term investment.
The degree to which you follow the steps above will determine your level of success as a workers’ comp clinic. We want to stress that profiting from work comp does not happen overnight. Your practice will likely not see profit for 18 months to 2 years, and even then, the amount of profit that you make depends on your efforts in marketing, joining multiple MPNs, and streamlining claims.
If it was easy, everyone would do it. If you take a step in this direction however, we want to thank you. Truly, workers’ compensation is an industry which is as interesting and necessary as it is convoluted. Every stakeholder involved with every claim will cherish a clinic who can get a workers’ comp claim open and closed in a timely manner with consistency and accuracy.