Guidelines and Reimbursement

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Presentation transcript:

Guidelines and Reimbursement L&I FAQs

Guidelines on treating work related injuries

Medical Management Minimize use of opiates Prompt return to work is encouraged Convey work restrictions to the patient’s employer Refer to Occ. Medicine clinic for follow up Prompt follow up encouraged, especially if time off

Administrative Considerations Patient fills out Report of Accident (ROA) and signs Provider complete as much as possible Sign and date form Complete Activity Prescription Form (APF) form Registration faxes form Not completing/faxing form rejects and/or delays care which correlates in poorer outcomes and increased disability!

Forms Report of Industrial Injury or Occupational Disease If you think the work injury is related to work on a more probable than not basis (more than 50% probability, you should mark “probably” or “yes” (blue section, box 7). If you think the injury is not related to work mark “no” or “possibly”.

APF Form

APF Form Filled out and submitted with initial ROA This info is in the middle of the APF form. Document whom you called, what was discussed (work restrictions and duration of restrictions) and the time it took

HIPAA

Reimbursement APF Form $52.36 Telephone call with employer $23.99 - $68.90 Report of Accident (L&I form) Within 2 business days $60.42 Within 3 - 5 days $40.28 Within 6 – 8 days $30.28 More than 9 days $20.28 Rates from July 2014 COHE Fee Schedule on www.lni.wa.gov

COHE 1. View the Enrollment webinar. https://www.chifranciscan.org/health-care-services/cohe/resources.html 2. Complete the Enrollment quiz. 3. Complete the COHE provider application (see attached) email completed form to the COHE Alliance of Western WA and cc Laurel Green… wwcohe@chifranciscan.org Laurel_Green@teamhealth.com

Talking Points With Patients Activity helps you recover Some discomfort is normal when returning to activities after an injury You can help with your own recovery You can protect yourself from re-injury Early and safe return to work makes sense

Summary L&I paperwork is vital to ensure quality patient care Registration key in facilitating and forwarding claims APF form does exist and should be clipped to all forms for completion 3 opportunities for reimbursement, up to $175+ per claim Document in EPIC that you completed ROA, APF and +/- call to supervisor