Worker's Comp Question

[Guest guest]

Group,

I have a new patient who was injured on 10/15/08. She already

initiated a claim through an occupational med M.D. He gave her a

written generic referral for Chiropractic. So I am not the attending

physician.

My questions are:

1. When does the 60 day/18 visit clock start ticking? From the date

of the injury, the date of opening the claim, or the 1st date treating

with me?

2. Do I just bill SAIF directly with a copy of the referral? No need

for the form 827 right?

Thanks in advance for the help.

Dr. Jamey Dyson

Advanced Chiropractic

1295 Wallace Rd NW

Salem, OR 97304

503-361-3949

drjdyson1@...

[Guest guest]

Hi buddy,

First, it is important to determine if the patient has been enrolled in an MCO and if so are you on the MCO panel?

Second, a "generic" referral note for "chiropractic" is not going to do it for the Workers' Comp carrier if you wish to get paid for your services. There are some very specific details the medical doctor must include in his referral note the little note scribbled on his scrip pad ain't going to get it. I recommend writing the note with all the details required for the MD simply because that haven't the time nor the simplistic knowledge of what the heck to write or what is required of them. Have a place for them to sign off on the referral note you create for them call them to give them a heads up and then fax the form to them with instructions to fax it back ASAP. Give me your fax number and I'll fax you an example of the form I put together (same for any of you colleagues out there that want the same!).

Third, the 18 visits or 60 days starts when they first present at your office.

Fourth, yes you simply bill SAIF directly but you must have that proper MD referral note and your chart notes must be complete as well including Start and Stop times for all physiotherapies that you bill for.....

Lastly, make darn sure you send a note and your chart notes to this referring medical doctor telling her or him what your findings were, your working DX, what your treatment will consist of and your wonderful (another chiropractic mircle coming) prognosis will be! You need to jump on this kindly referral from the MD like "a hog after strawberries!"

Ok really lastly, remember that if your patient/worker is enrolled into an MCO the carrier must notifiy your patient in writing and even then via the "continuity of care" provision you have 10 days from the date of the letter inwhich your patient can continue to see you before they must see a DC on panel ( a whole approx 55 "CareMark Comp" or 56 "Providence MCO" out of over 600+ of my dear colleagues in th Portland-Metro area which is BS! and something I as your lobbyist am committed to changing no matter how long it takes and no matter how many asses I have to kick!!!!!!)

Hope this helps,

Vern Saboe

Worker's Comp Question

Group,I have a new patient who was injured on 10/15/08. She already initiated a claim through an occupational med M.D. He gave her a written generic referral for Chiropractic. So I am not the attending physician.My questions are:1. When does the 60 day/18 visit clock start ticking? From the date of the injury, the date of opening the claim, or the 1st date treating with me?2. Do I just bill SAIF directly with a copy of the referral? No need for the form 827 right?Thanks in advance for the help.Dr. Jamey DysonAdvanced Chiropractic1295 Wallace Rd NWSalem, OR 97304503-361-3949drjdyson1comcast (DOT) net

[Guest guest]

From personal experience of getting some claims paid and others not, I add to Vern's commentary.

Worker's comp law REQUIRES that you provide a treatment plan showing frequency, duration, modalities, etc back to the Attending physician within 7 days of seeing the patient. The AP must sign off on the Tx plan and forward it to the WC carrier.You bill WC with your standard process. If your bill gets denied, you have 90 days to appeal the denial, and they are tight on this. I lost a claim because even though my tx was effective and properly documented, I didn't appeal SAIF's denial until 100 days. SAIF is rigid on this, other carriers are a little more reasonable. R Johansen D.C.,DABCOChiropractic Life Center12762 SE Stark StreetPortland Oregon 97233Voice 5032557746,Fax 5032550818-- "Vern Saboe" <vsaboe@...> wrote:

Hi buddy,

First, it is important to determine if the patient has been enrolled in an MCO and if so are you on the MCO panel?

Second, a "generic" referral note for "chiropractic" is not going to do it for the Workers' Comp carrier if you wish to get paid for your services. There are some very specific details the medical doctor must include in his referral note the little note scribbled on his scrip pad ain't going to get it. I recommend writing the note with all the details required for the MD simply because that haven't the time nor the simplistic knowledge of what the heck to write or what is required of them. Have a place for them to sign off on the referral note you create for them call them to give them a heads up and then fax the form to them with instructions to fax it back ASAP. Give me your fax number and I'll fax you an example of the form I put together (same for any of you colleagues out there that want the same!).

Third, the 18 visits or 60 days starts when they first present at your office.

Fourth, yes you simply bill SAIF directly but you must have that proper MD referral note and your chart notes must be complete as well including Start and Stop times for all physiotherapies that you bill for.....

Lastly, make darn sure you send a note and your chart notes to this referring medical doctor telling her or him what your findings were, your working DX, what your treatment will consist of and your wonderful (another chiropractic mircle coming) prognosis will be! You need to jump on this kindly referral from the MD like "a hog after strawberries!"

Ok really lastly, remember that if your patient/worker is enrolled into an MCO the carrier must notifiy your patient in writing and even then via the "continuity of care" provision you have 10 days from the date of the letter inwhich your patient can continue to see you before they must see a DC on panel ( a whole approx 55 "CareMark Comp" or 56 "Providence MCO" out of over 600+ of my dear colleagues in th Portland-Metro area which is BS! and something I as your lobbyist am committed to changing no matter how long it takes and no matter how many asses I have to kick!!!!!!)

Hope this helps,

Vern Saboe

Worker's Comp Question

Group,I have a new patient who was injured on 10/15/08. She already initiated a claim through an occupational med M.D. He gave her a written generic referral for Chiropractic. So I am not the attending physician.My questions are:1. When does the 60 day/18 visit clock start ticking? From the date of the injury, the date of opening the claim, or the 1st date treating with me?2. Do I just bill SAIF directly with a copy of the referral? No need for the form 827 right?Thanks in advance for the help.Dr. Jamey DysonAdvanced Chiropractic1295 Wallace Rd NWSalem, OR 97304503-361-3949drjdyson1comcast (DOT) net

_____________________________________________________________Click here for free information on how to reduce your debt by filing for bankruptcy.

[Guest guest]

good points Ron however colleagues I would simply add that you don't wish to depend on the MD to send in the treatment plan.....you send it in with your billings and chart notes and make darn sure you refer to the MD's referral/treatment plan within your chart notes or via separate one page note (....and don't be a knucklehead and attempt to bill the carrier for that one page note.....they didn't request it and will not pay for it....but your treatment will likely indeed be paid for......).

Vern Saboe

Worker's Comp Question

Group,I have a new patient who was injured on 10/15/08. She already initiated a claim through an occupational med M.D. He gave her a written generic referral for Chiropractic. So I am not the attending physician.My questions are:1. When does the 60 day/18 visit clock start ticking? From the date of the injury, the date of opening the claim, or the 1st date treating with me?2. Do I just bill SAIF directly with a copy of the referral? No need for the form 827 right?Thanks in advance for the help.Dr. Jamey DysonAdvanced Chiropractic1295 Wallace Rd NWSalem, OR 97304503-361-3949drjdyson1comcast (DOT) net

_____________________________________________________________Click here for free information on how to reduce your debt by filing for bankruptcy.