Occupational Health — Workers Comp and DOT, Handled

Proven Results

• 23.8% Revenue Increase
• 97.8% First-Pass Claim Rate
• 40.2% Faster Reimbursement
• 99.2% Policy Compliance

Common Billing Challenges

Complex Modifier Requirements

Telehealth billing requires specific modifiers and place-of-service codes that vary by payer and service type.

Cross-State Compliance

Different states have varying telehealth regulations, licensure requirements, and reimbursement policies.

Evolving Payer Policies

Telehealth coverage policies constantly change, especially post-pandemic with varying permanent adoptions.

Time-Based Documentation

Proper time tracking and documentation required for virtual E/M services and counseling codes.

Technology Platform Billing

Different telehealth platforms and modalities require specific coding approaches and documentation.

Parity Payment Issues

Not all payers reimburse telehealth at parity with in-person visits, requiring revenue optimization strategies.

Our Solutions

Telehealth Billing Experts

Our team specializes in virtual care billing with up-to-date knowledge of modifier requirements and payer policies.

• Accurate telehealth modifier application
• Real-time payer policy updates
• Synchronous and asynchronous billing expertise
• State-specific compliance management

Compliance & Credentialing

Ensure proper credentialing and compliance across all states where you provide telehealth services.

• Multi-state licensure tracking
• Interstate compact billing support
• HIPAA-compliant telehealth billing
• Platform-specific documentation review

Revenue Maximization

Optimize telehealth reimbursements through proper code selection and payer-specific strategies.

• Maximum allowable billing for virtual services
• RPM and CCM code optimization
• Virtual check-in billing capture
• E-visit and e-consult billing

Platform Integration

Seamless integration with major telehealth platforms and EHR systems for efficient billing workflows.

• Automated claim generation
• Time tracking verification
• Documentation completeness checks
• Real-time eligibility verification

Specialized Services

Synchronous Telehealth

Expert billing for real-time video and audio consultations with proper E/M coding.

• Live video visit billing
• Audio-only services
• E/M level selection
• Telehealth modifier application

Asynchronous Services

Specialized billing for store-and-forward telehealth and e-consults.

• E-visit billing
• Online digital evaluation
• Store-and-forward imaging
• Interprofessional consults

Remote Patient Monitoring

Comprehensive RPM billing including device setup, data collection, and management time.

• RPM setup billing
• Monthly monitoring codes
• Device supply billing
• Time tracking documentation

Chronic Care Management

Complete CCM billing for virtual chronic condition management and care coordination.

• CCM time tracking
• Complex CCM billing
• Principal care management
• Behavioral health integration

Common CPT Codes Reference

Key codes include 99203 (New patient office visit, 30–44 min, moderate complexity), 99213 (Established patient visit, 20–29 min), 99455 (Work-related or medical disability examination), 99456 (Work-related or medical disability examination by other prov), 99080 (Special reports or forms completion — beyond medical record), 36415 (Collection of venous blood by venipuncture), 93000 (Electrocardiogram with interpretation and report), 94010 (Spirometry with graphic record), 99173 (Screening test of visual acuity), 73030 (X-ray, shoulder, minimum 2 views). Proper code selection requires understanding of bundling rules, NCCI edits, and modifier usage.

Expert Billing Insights

Workers' Compensation Billing: Fee Schedules and Documentation

Occupational health billing for workers' compensation claims follows state-specific fee schedules, not Medicare or commercial rates. Each state has its own WC fee schedule (or uses RBRVS with state-specific conversion factors). Workers' compensation claims require specific documentation: mechanism of injury, body part affected, causation opinion, functional limitations, and work capacity. Every claim must reference the injury date (date of accident, DOA) prominently. Missing or inconsistent causation documentation is the most common WC billing dispute trigger.

• Bill WC claims at state fee schedule rates — not standard charge master rates
• Document employer name, date of injury, and claim/adjuster contact on every WC claim
• Causation opinion must be explicitly stated: "the injury is causally related to the workplace incident of [date]"
• Work status documentation: full duty, modified duty, or off-work with specific restrictions

DOT and Pre-Employment Physical Billing

Department of Transportation (DOT) physicals for commercial drivers are a significant revenue stream for occupational health clinics. DOT physicals must be performed by a FMCSA-certified medical examiner and documented on FMCSA Form 649-F. The physician's professional fee is billed to the employer or driver directly — DOT physicals are not typically covered by health insurance. Pre-employment physicals follow similar direct-billing structures. Other occupational medical surveillance (respirator fit testing, asbestos screening, hearing conservation) are billed at the employer rate.

• DOT physical: bill employer directly — not medical insurance (health plans exclude employer-required exams)
• FMCSA medical examiner registry certification required — verify your clinicians are on the national registry
• Document all physical examination components required by DOT CMV regulations
• DOT drug screen: bill collection (36415) and lab (87300-series) separately; DOT 5-panel required

Return-to-Work Programs and Functional Capacity Evaluations

Return-to-work (RTW) coordination and functional capacity evaluations (FCEs) are core occupational health services that carry significant billing opportunity. FCEs are multi-hour assessments documented with objective validity testing and billed using time-based therapy codes. RTW letters and medical reports (99080) are separately billable administrative services. Disability and impairment ratings under specific rating systems (AMA Guides, state-specific) require specialized training and support premium coding.

• FCE: 97750 per 15-minute unit; comprehensive FCE may involve 4–8 hours = 16–32 units
• Work capacity opinion letters: 99080 for administrative form completion
• Impairment rating reports: 99456 (independent physician) or 99455 (treating physician)
• Job analysis documentation review billed as data complexity in E/M medical decision-making

Payer-Specific Billing Tips

Workers' Compensation Carriers

• Every state has a different WC fee schedule — obtain and use correct schedule for each claim
• Adjuster authorization required before specialty referrals, MRIs, and non-routine procedures
• Lien letters: obtain from WC attorney if case is in dispute — do not stop treating for non-payment
• Report on a paper CMS-1500 or electronic 837P with the WC billing flags properly set

Self-Insured Employers

• Self-insured employers negotiate rates directly — understand your contract before billing
• TPAs (Third Party Administrators) manage self-insured WC claims — bill TPA, not employer directly
• Occupational health retainer contracts: some employers pay monthly retainer for clinic services
• Group health billing: injuries not meeting WC causation standards shift to health insurance billing

DOT and Employer-Pay Services

• DOT physicals, pre-employment exams, and drug screens billed to employer — not health insurance
• Establish employer accounts with net-30 payment terms and billing contacts
• Drug screen billing: bill collection fee (36415) plus lab separately — or use contracted lab
• OSHA-required medical surveillance: bill employer at negotiated rate; not billable to health insurance

Medicare/Medicaid (Injured Workers)

• Medicare is always secondary to WC — do not bill Medicare until WC is resolved or denied
• Medicare Set-Aside (MSA) arrangements protect Medicare from future medical costs in WC settlements
• If WC denies injury, bill health insurance with appropriate ICD-10 and documentation
• Medicaid: coordinate WC and Medicaid — Medicaid has subrogation rights for WC injuries

Key Services

• occupational health billing
• workplace health billing
• workers comp billing
• employee health billing
• occupational medicine billing