When a provider treats a patient as a result of work-related injuries, there is an entirely different set of federal and state rules and procedures that must be adhered to with regard to billing that patient’s claim. Patients who file a First Report of Injury are protected from balance billing, even in out-of-network situations. And many states have adopted very specific Physician Fee Schedules that vary greatly from hospital and other facility mandated compensation. Not to mention, most states prohibit fee schedules to be utilized by payers when the patient received emergency care in a hospital. Yet, hospitals routinely find themselves reimbursed based on Physician Fee Schedules, improper bundling, multiple levels of network discounts on top of fee schedule payments, and so on.
- TGF represents medical providers’ rights to proper compensation by Workers’ Compensation carriers, as well as self-funded employers, when applicable.