Workers’ Comp Billing Simplified with ADSRCM (Outsourced) or ADS (In-House Automation)

Workers’ Compensation (WC) billing is one of the most detail-driven, regulation-heavy segments of medical and legal revenue cycle management (RCM). It demands precision, organization, and an ability to track complex data points over potentially long case timelines.

In 2023 alone, the National Safety Council (NSC) reported the total cost of work-related injuries at $176.5 billion — including $36.8 billion in medical expenses and $53.1 billion in lost productivity (NSC Work Injury Costs).

For providers and law firms managing WC cases, the stakes are high. Every missing authorization, incorrect case number, or expired approval can cost thousands of dollars in lost reimbursements.

Key Challenges in WC Billing

1. Multiple Cases Per Patient
   A single patient might have multiple WC claims from different accidents, each with its own authorizations, attorneys, and carrier case numbers. Without proper indexing, records become a mess.
2. Strict Authorization Management
   WC treatment plans come with exact visit limits. If you exceed them — or fail to get new approvals in time — claims will be denied.
3. Data Synchronization
   WC Board numbers, carrier case numbers, accident dates, and provider notes must align perfectly across systems and submissions.
4. Extended Case Timelines
   WC cases can span years. If records aren’t structured and accessible, staff can waste hours chasing documents.

How We Simplify WC Billing

The pain points of your WC billing can be dramatically reduced if not totally eliminated:

• Single Financial Patient Account: Support multiple cases per patient keeping each case financially and clinically separated.
• Case-Specific Indexing: Organize sub-accounts by case name, accident date, carrier case number, WCB case number.
• Real-Time Authorization Countdown: Tracks remaining visits to prevent overages.
• Integrated Scheduling Alerts including those for out-of-network appointments, expiring authorizations, prior authorizations, and copayments
• Search by Case Number: Instantly pull up the correct chart and records.

Best Practices for WC Billing

1. Always Verify Before Scheduling — Eligibility and authorization checks upfront prevent denials later.
2. Document Every Detail — Include accident date, attorney info, WC case numbers, and all carrier data in the record.
3. Monitor Visit Counts Weekly — Don’t rely on memory; use an automated counter.
4. Audit Records Monthly — Spot gaps before they become payer disputes.

Why This Matters

Every claim denied represents a major hit to revenue. Streamlining WC billing is not just an operational improvement — it’s a financial safeguard.

Attorney Management

With WC patients you need a built-in attorney database cleanly linking patients with their attorneys/law firms. It must be case-specific for patients who have different attorneys for multiple incidents and be easily editable since attorneys often change along the way.

You’ll also want lien management to ensure nothing slips through the cracks. 

And then, a secure self-serve attorney portal option enabling them to do much of their own lookups and retrievals, on-demand, would free your staff from having to do their work.

If you’re tired of WC billing complexity eating into your revenue, we can bring order, compliance, and faster payments to your workflow whether you prefer outsourcing with ADSRCM or by using the MedicsCloud Suite from ADS as an in-house automated platform. We support everything mentioned, including attorney management as described.