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First Report of Injury Coding Goes From Important To Critical

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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.

 

Pic of keyboard person First Report of Injury Codeing
Wikimedia Commons Santeri Viinamäki

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

Hands presenting First Report of Injury Coding wed design concept
StockUnlimited

Two areas should be considered when filing a claim for the proper first report of injury coding:

  1. 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.
  2. 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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James Moore

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications

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