Discuss confidentiality when processing workers' compensation claims. What rights does an employee have? What kinds of information do both the medical biller and claims examiner need to submit a claim?

Question

What will be an ideal response?

Answer 1

Answer:
If a patient is being treated for a work-related injury, all records relating to the injury and treatment should be kept separate from the patient's regular medical records. Since employers are covering the costs of treatment, privacy guidelines are somewhat different from the normal privacy agreement between the insured party and the provider. In WC cases, the agreement is actually between the medical provider and the employer, not the patient (employee). The employer may request to see records regarding the injury, and these records may be subpoenaed. No information pertaining to the employee's non-work-related treatment should be made a part of this file, so that confidentiality between the provider and the patient is not breached for non-work-related treatments and conditions.
A medical biller will need the following to submit a claim; the claims examiner will need a copy of the following reports to process a claim properly:
• Doctor's First Report
• Subsequent Progress Reports
• Physician's Final Report