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Provider Newsletter - March 2013

Provider News

This is a periodic roundup of L&I news for medical providers. To subscribe by email, join our Medical Provider News email list.

You can also read previous Provider News editions.

In the Provider News for March 2013:


A new treatment guideline for prescribing opioids will become effective July 1, 2013

Starting July 1, L&I will implement the new Guideline for Prescribing Opioids to Treat Pain in Injured Workers. By using the best practices in the new guideline, you will improve the care of injured workers and help save lives. We encourage you to review the new guideline (660 KB PDF) and adopt the best practices before implementation.

The department is going through a rulemaking process to implement the new guideline and other changes. We are seeking input from the public on the draft rules; you can review the summary of the rulemaking (CR-102 form) and the proposed language.

The comment period is open until April 23. A hearing is scheduled for April 23, 2013 at 1 p.m., at L&I's Tukwila service location.

Questions?
For policy questions, contact L&I's pharmacy manager at Jaymie.Mai@Lni.wa.gov.
For questions related to this rulemaking process, contact Jami.Lifka@Lni.wa.gov.


Consultants wanted for file reviews on open claims

In early April L&I will publish a request for medical consultants to provide file reviews on open claims for injured workers and crime victims.  This request is not for IMEs or examinations.  We are seeking clinicians in the following disciplines: oncology, oral surgery, CRI occupational medicine, psychiatry, occupational medicine, orthopedics, neurology, internal medicine, podiatry, physiatry, chiropractic, ENT, dental, and physical therapy.

Although L&I does not guarantee a minimum number of consulting hours, the expected volume is approximately 5–20 hours per month per contractor, depending on the specialty.  The exception is physical therapy, which could involve 80+ hours of consultation each month.

Around April 12, L&I will publish RFQQ K2730 at Washington's Electronic Business Solutions (WEBS) website. To learn more or submit a bid, please register there using commodity code 948-74.

If you register on WEBS after April 11, please search for the posting. If you have any questions, contact Christine Cook at 360-902-5024.

L&I has contracted with medical experts to advise attending physicians on patient care since 1985.  Consultations with medical experts are essential to the care of injured workers and crime victims. They are also necessary for decision-making on workers compensation claims. 

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L&I launches new ad campaign to promote return to work

Providers are key partners in fostering return to work during recovery. So we hope you'll be interested in our new advertising campaign that encourages employers to provide light-duty jobs for their employees while they recover from workplace injuries. The advertising campaign, called “Working Solutions”, also promotes online claim filing. By getting new claims to L&I faster, online filing speeds up efforts to help injured workers return to work.

Spokane-area providers: the campaign's first ad has started playing on television in your area. In it, a blue-collar guy discovers an unexpected talent while recovering from an injury. Check it out below. The ad will be broadcast later on the west side of the Cascades.

The ads will be shown both on television and on the web. For more information about the campaign, read our news release.

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Learn how to make 2 new L&I programs work for you - participate in a webinar

Do you value your role in helping injured workers return to good health and their jobs? Register for a free webinar that will explain how your healthcare practice can use online claim filing and the Stay at Work program to get even better at it.

A number of the 90-minute webinars are scheduled through the end of 2013. Space is limited. To ensure your place at the session of your choice, please register in advance.

FileFast allows medical providers and injured workers to file a claim online. (Workers can also file by phone.)  Among other benefits for providers, filing online speeds claim receipt by 5 days over paper filing and helps create return-to-work opportunities for the injured worker.

The Stay at Work program provides eligible employers with 50% of the base wages paid to an injured worker for a light-duty or transitional job.  By highlighting this benefit, providers can encourage employers to provide light-duty jobs for their workers recovering from injuries. More than 1,600 employers have used the Stay at Work program to keep 6,500 workers on the job.


Get results on underpaid Self-Insurance medical bills!

Getting L&I involved can help you persuade self-insured employers and their third-party representatives (TPAs) to work collaboratively with your office to pay their bills correctly.  Here's a recent illustration of how we can help.

The story
An independent medical examination (IME) company submitted 13 disputes to L&I's Self-Insurance Program using the new Self-Insurance Medical Billing Dispute form. Most of the underpaid bills were for the same employer on different claims managed by the same TPA.  The IME company began contacting the TPA via fax and email, referencing the new form and cc'ing the department.

The outcome
Soon after, the TPA took the initiative and started working directly with the IME company to resolve the bill payment issues. As a result, the IME company has asked Self-Insurance staff to hold the disputes because the bills are getting paid correctly.

So it's worth the time to fill out and send in the Self-Insurance Medical Provider Billing Dispute form!

Questions? Contact L&I's Self-Insurance staff at 360-902-6901.


3 things you should know to avoid problems when billing Medicare and workers' comp

If you decide to bill Medicare for any treatment under a workers' comp claim or for treatment similar to the workers' comp injury, be careful about your billing. An overpayment by Medicare could result in your office being unable to bill Medicare even after the L&I claim is closed.

  1. If a worker has an allowed workers' compensation claim, L&I is always the primary payer for the treatment. Medicare is never a secondary payer for workers' comp.
  2. The only time that Medicare rules allow billing for workers' comp injuries is when a claim is not allowed or if a claim is in question and there will likely be a delay in payment from the workers' compensation carrier. If this situation comes up, your need for prompt payment may prompt you to bill Medicare. However, these Medicare payments are conditional: if you receive payment from L&I or a self-insured employer or their claim administrator, you must promptly repay Medicare.
  3. Medicare does NOT allow billing for the difference between what L&I pays and a provider's usual fee — which some providers try to do. When providers join L&I's Medical Provider Network or get an L&I provider number, they agree to accept L&I payments as payment in full. Medicare also considers this payment in full per the Medicare Secondary Payer Manual, Chapter 1.

Maintaining a good relationship with Medicare will help insure that your patients can get treatment they need.

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eCorrespondence is coming soon! Are you getting ready?

Did you know that health care providers soon will have the option of receiving most claim-related L&I correspondence and legal orders electronically?  eCorrespondence will be available in early May.

How will eCorrespondence work?
You will be given the option to choose either electronic or paper-mail delivery of your claims-related documents.  Each working day that you have new correspondence, you will receive an email containing a link to your eCorrespondence inbox.

Will I access my eCorrespondence in L&I's Claims and Account Center?
No.  We're always working on new online services, but at this point, eCorrespondence will instead be delivered to the email address of the person you choose to administer your incoming mail.

Should I start planning for eCorrespondence now?
We recommend it.  After all, you now have staff assigned to opening and routing your paper claims correspondence. Think about how you'll make the switch to an electronic inbox.

  • Decide who in your organization will be the main administrator for your eCorrespondence account.  This person will be in charge of assigning access to others in your practice, clinic or hospital.
  • You will be able to save your incoming eCorrespondence to your own system. Think about how you want to organize and distribute this mail.  Your eCorrespondence inbox will display much information about what each piece of mail contains (unlike a plain L&I envelope).

Will I be able to reply — in the same application — to my incoming eCorrespondence?
Not at this time. After you delete what you don't need, you'll route your mail to your own system for handling.

How will L&I let me know when this service is available?
We will have announcements on our website, on the back of every claims-related envelope you receive, and on much of the correspondence you receive.  At that time, you will sign up for eCorrespondence through Secure Access Washington by “adding a new service.”  Your service will begin the day after you sign up.

Watch for more information from us about eCorrespondence!

 

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