Treating workers’ comp patients is one thing. Getting paid for it is another.
Workers' compensation billing can feel like a maze. Every state has its own rules, documentation requirements and claim timelines. With the right process in place, PT clinics can get paid fairly for the care they provide.
1. Confirm the Injury Is Work-Related
This step happens before treatment even begins. Always ask: “Was this injury work-related?” If this isn’t confirmed up front, the clinic might mistakenly bill the patient’s primary insurance, leading to denials and delayed care.
2. Gather All Claim Information
- Claim Number
- Adjuster Name and Contact Info
- Injury Details
- Employer and Carrier
- Ensure The Approved Diagnosis Matches The Claim To Avoid Rejections
3. Get Written Treatment Authorization
Don’t start treatment without it. Verbal approval is helpful, but written authorization is your protection. If more visits are needed later, contact the adjuster early to extend approval and avoid hitting a hard stop mid-treatment.
4. Track Visits and Submit Clean Claims
Also, workers' comp patients don’t pay copays or deductibles. PT clinics must accept the approved reimbursement as full payment; no balance billing allowed.
Because insurance companies tend to use PPO, Network and Retroactive Discounts to lower your payments, hundreds of Physical Therapy clinics across the country BOOST their claims. Having your billing run claims through BOOST, you should get $53 more per claim on average. You also have the reassurance that you are getting the reimbursement you deserve, maximizing revenue.
5. Use the Right Forms and Know the Law
- First Report of Injury (at first visit)
- CMS-1500 form with detailed documentation
Follow HIPAA guidelines and don't bill the employer directly. Always consult your state’s workers’ comp regulations to stay compliant.
Want to simplify all of this?
BOOST works with clinics to manage these exact details — ensuring proper documentation, authorization, and submission — so PTs get reimbursed faster and at higher rates. It’s not a billing replacement; it’s a partner that helps you get what you’ve already earned with no PPO, Network or Retroactive Discounts. boostmyclaims.com