Category: LNI News (Page 7 of 22)

L&I Claim Medical Aid Rules and Fee Schedule

With an L&I claim or workers’ comp claim in Washington State, it can be very difficult to understand treatment payments, policies, and procedures. This is a big problem for L&I medical providers in the provider network (or MPN) and for people that have a work injury claim. For doctors, it’s challenging to know which billing codes to use. On top, it’s hard to tell the rates that the Department of Labor and Industries (L&I) pays for services. Finally, it’s unclear if and what services require pre-authorization.

L&I resources for medical questions

L&I created resources to address the challenges mentioned above. Unfortunately, many medical providers as well as work injury claimants don’t know that these resources exist or where to find them. Yet, questions about medical billing and fees arise in every workers’ compensation claim.

The L&I treatment policies are available in the Medical Aid Rules in chapter 296-20 of the Washington Administrative Code, or WAC in short. Reading or referencing the WAC can be frustrating and time consuming. After all, it’s code that people use mostly for legal purposes. Furthermore, not everyone is familiar with the administrative code writing style and language.

The L&I fee schedule reference

Fortunately, L&I has some useful and user-friendly tools on its website. For example, L&I publishes its annual Payment Policies and Fee Schedules, by year. One of the resources within these publications is a Quick Reference Card. Interestingly, this card contains the most common and frequently used codes. However, for services that are not available in the Quick Reference Card, there are several ways to find the fee schedule and payment policies.

Billing code lookup in an L&I claim

If you know a billing code, then L&I has a Fee Schedule Lookup tool that you can use. Here, simply enter the code and a box appears outlining coverage, fees, and authorization requirements. For example, for billing code 10004, we get the following information from the L&I website.

Even better, in cases where you must obtain pre-authorization, you can click the link that writes “Yes – Claim Manager”. After that, it redirects you to the pre-authorization form that you’ll have to use. Finally, it’s worth noting that many providers find it surprising that many treatments and services do not require pre-authorization.

Preventing Work Injury and L&I Claim Occurrences Among Young Workers

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A catastrophic work injury is devastating and life-changing event. This is especially true when we talk about first-time or young workers that suffer an injury on the job. In fact, these are some of the most gut wrenching and challenging cases I handled during my career as a workers’ compensation attorney. Fatal work accident injury incidents are always emotionally difficult. However, they are significantly harder when they involve our younger workers.

Work injury among teen workers

According to studies, workers between the ages of 16 and 20 sustain more cases of injury at work than older workers. I previously wrote about some of these work injury examples. Consequently, Washington State employers that employ a higher percentage of young workers are likely to experience higher workplace injury rates. If you look around, young employees are part of the labor force in many common industries such as retail, hospitality, and the service industry. Moreover, we often see younger individuals taking jobs in health and fitness, childcare, and the automotive industry.

Some researchers suggest that young workers incur more work injury occurrences because they take more safety risks. Others attribute it to lack of experience and knowledge. Regardless of why it happens, we can all agree that improving safety and reducing the chances for workplace injury is an important goal.

How to reduce L&I claim incidents for young employees

Employers are always responsible for teaching their workers about work safety. However, additional resources such as the SAFEME app can help as well. For example, this application supplements employer safety education and targets younger workers. It aims to educate members of our younger labor force about how to work safely. The app is free. It’s available online and also for iPhone and Android.

The Department of Labor and Industries (L&I) helped to fund, develop and support the SAFEME application. Furthermore, in recent news, the Washington Retail Association secured a grant to translate the SAFEME app to Spanish and provide 24 training lessons. This work safety app is quickly becoming a useful resource for both employers and workers. I applaud this initiative and wholeheartedly hope that it will lead to safer work practices for employees in Washington State.

L&I Claim Payment Coverage: New Billing Code Helps Providers with Online Communication

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The attending provider (AP) has an important role in your workers’ compensation claim. In many cases, people with a work injury claim have trouble finding a doctor for an L&I claim. That’s because many medical providers are simply not willing to get involved with L&I claims. In fact, from my personal experience, medical providers don’t feel they get fair payment for the time they spend responding to administrative inquiries. Sometimes, this is true. However, many providers don’t realize they can bill for time spent on responding to L&I, to claim managers, to administrators and others. The Department of Labor and Industries (L&I) has several billing codes for administrative work. For reference, providers can find the appropriate L&I billing code for admin work in the L&I billing and payment policy manual.

New billing code for workers’ compensation claim providers

Recently, L&I announced an important new billing code that providers can use for online communications with patients and beyond. L&I created the new billing code largely due to COVID. During COVID, many in-person appointments converted to remote or online sessions. Specifically, the new billing code is 9918M. Many treating providers can use this billing code; it’s not limited to the attending provider. More explicitly, attending providers, consultants, psychologists, physical and occupational therapists, and nurse case managers may all use this code. Moreover, they can use this code once per claim per day.

What does the new code cover in my workers’ comp claim?

L&I claim providers can use the billing code to charge for the following work:

1) Non in-person follow-ups to prior in-person appointments.

2) Non-urgent consultations for L&I claim accepted conditions (assuming the provider would otherwise charge for an equivalent in-person appointment).

3) Reporting and interpreting diagnostic tests that require discussion, medication, or treatment adjustments.

4) Detailed discussions regarding care or treatment plans and medical rationale.

5) Discussions regarding employability.

6) Detailed discussions concerning non-compliance to L&I claim managers, and

7) Discussions with work injury claimants, employers, vocational counselors, and claims managers relating to return to work

How is this L&I billing code different?

Unlike before, this code allows providers to bill for communications with non-patient claim parties including vocational counselors. Consequently, it’s important to note that the prior codes 99444 and 98969 are no longer active. There’s no question that L&I claims can be time consuming for providers. Especially when it comes to administrative tasks. However, like this new code for online communications, there are many ways providers can bill for the time they spend on workers’ compensation claims.