First Report of Injury Coding Now Even More Critical Than Before
The First Report of Injury Coding now becomes something to watch for in the next five years. Well, you should have been watching the coding before now if you had online access to your claims.
Why was a decision made to write this article? Last week, I wrote an article on California’s WCIRB.
The article was republished quite a few times out in the blogosphere. You may want to follow the link previous link to see the caveats and how to avoid them for any COVID-related claims in California.
The WCIRB decided to NOT ADD IN any COVID-related claims to an insured’s X-Mod. Yes, if the claim is related to the Coronavirus, an employer will not incur the addition of that claim to their Mod.
NCCI will likely follow suit on not COVID-related claims not pegging to the E-Mod. X-Mod and E-Mod represent the same term. Most Californians refer to the Experience Modification Factor as the X-Mod.
Two Important Areas for Proper Coding
Two areas should be considered when filing a claim for the proper first report of injury coding:
Do not file every claim you have as COVID-related. This came in as a question from the article published last week. Are not all claims related to COVID in March and April of this year? No, do not consider them all COVID claims. Do not reduce your integrity with your worker’s comp claims department.
- Use your carrier or TPA’s online claims reporting system. Why? The online systems usually allow an employer to differentiate the disease claims. In other words, you are coding the claim properly and someone in the data input department will review your input. Carriers and TPA’s may charge a fee to input a paper claim.
When a carrier or TPA receives the first report of injury (paper, call-in, or online), a few steps are involved for data input to release the first report of injury to the supervisor then the proper lost time or medical only adjuster. Online claims reporting assists in the process. (See #2 above).
One mistake that I have seen over the years that causes much confusion originates with the treating physician not denoting the claim as a disease-based claim. The medical only or lost time adjuster may figure this out, but rarely have I seen adjusters change the coding once the claim is set up except medical only to lost time.
An adjuster will usually review it once for a few seconds. I have seen four claims where the adjuster changed or requested a change to the type of coding.
First Report of Injury Coding Follow-up
The easiest way to follow up in making sure the coding matches the injury (disease) involves online access. Most carriers and TPAs have a coding section where you can review to see what coding was entered. If you have online first report capabilities this is a simple task. Paper loss runs make this a much more difficult task.
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