We recently had a discussion regarding the Oregon rules for accepting accounts that may or may not be involved in a workers compensation claim, and the ending liability for patients who fail to request full payment of the claims. There can be many “moving parts” to a workers comp claim, so specific cases may need proper legal counsel to verify the correct procedure, but in general, this is how it works:
It is not unusual for a lawyer to tell us or our client that “sending an account to collections” or “attempting to collect an account” while a workers comp claim is ongoing is “illegal”. Not exactly… ORS 656 covers this area and we can see an account CAN be assigned for collections and collection activity CAN proceed AFTER a final determination in the case is made. If there is an ongoing trial and/or claim, then the lawyer is correct and no collection can take place. However, if the claim is denied, then the provider can bill the patient’s health insurance and proceed with normal collection activity.
IF there is an appeal filed then collections need to stop while another final determination can be made. After that, the worker can be liable for any amount not paid by the claim, unless the worker requests 100% payment for the bill per the payment schedule in ORS 656.248. It may be prudent for you to bill the health insurance, or wait if you get the sense an appeal will result in payment. Sometimes, there is more work in billing, refunding, billing, refunding, billing, getting paid etc. then just waiting for the case to run it’s course. You want to bill the health insurance in time to avoid non-payment for “timely filing”, and ultimately we may not be able to collect the balance from the worker.
Southern has a procedure in place to work with and process these cases in the event an account is assigned and then it is discovered there is an ongoing claim or an appeal is filed. We do not credit report and all legal action is stopped during this time, and we deal directly and only with the lawyer representing the worker. Our experience with most of the lawyers who do this kind of work around southern Oregon has been favorable, and we have a good working relationship with their staffs.
If you get an account that is denied by workers comp, you can send it to us for collection. If an appeal is filed, we can hold the account activity pending the outcome and final determination. If you are not paid in full, you may be able to collect the difference from the worker. Our Client Consultants can assist if you have questions about our procedure or a specific account, but don’t give up on getting paid just because there is a claim filed.