Billing insurance vs work comp

A patient of mine had a work comp case for her shoulder that she thought was closed out (I have not been involved in with this at all).  She also has insurance coverage for acupuncture which I started billing for her in January.  

She just found out from her work comp rep that she can submit superbill receipts for up to 10 acupuncture treatments on her shoulder (current or retroactive).  In the meantime, I have been billing her insurance company for these visits with the code for migraines which I am also treating and they have been applying it to her deductible. 

Am I allowed to give her the superbill receipts for these same dates of service to give to her work comp for reimbursement?  Is that completely separate from insurance or do they see that as double-dipping?  This is the first time I’ve run into this situation.  Thanks for your help!

This gets to be a bit tricky on a few levels. Were you treating her for her shoulder and migraines at the same time and are you still treating for one of both of them? Am I understanding you right that you are billing her medical insurance for her migraines but all of that has went to her deductible and none to you? I can give better advise once I know those details but if you were treating for both migraines and her shoulder injury and only billed her medical insurance and it was going toward her deductible, there could be a way to bill her Work Comp since you did not do any billing for the shoulder. Again, it is tricky – a grey area – but just because acupuncturists treat more than one thing at a time should not mean there could not be coverage from two different insurance companies with liability for two different medical conditions as long as you actually treated those two things. You should not bill each insurance for an office visit on the same day but the therapy might be able to be billed to each one. 

Matthew Bauer

I treated her for migraines, shoulder pain, and hot flashes in the same visit for 7 visits so far in 2013.  

I’ve billed insurance for those 7 visits using the code for migraines only, and 97810 treatment only (I haven’t billed an office visit on her)

She pays me up front and I bill her insurance on her behalf.  I get nothing directly from her insurance, though that may change on future visits.  At least for most of these, it all went to her deductible.  I called today to verify that she has now met her deductible but I didn’t have enough time to check individual service date claims to see when exactly that was met.  

We did also do 8 treatments in 2013 that could probably be submitted instead since they will take retroactive that far back. And these were NOT sent to insurance at all. But on those, I don’t have as much about her shoulder documented since we were focused more on her hot flashes then. The chart notes only make brief mention of the shoulder pain, and there were no local shoulder points used during those treatments – no one is currently asking for any copies of chart notes, but I was concerned they would question it if they ever did need these.  This is where I find it sticky with acupuncture because points don’t need to be local to be beneficial but it does make the documentation confusing for western-based evaluators.

Thanks for helping me navigate through the confusion! What is the right thing to do? 

Okay, one last question to make sure I understand… So it’s best to not to give her the superbill for any of the past treatments, neither this year’s, nor last year’s.  Instead, her future treatments (up to the 10 allowed) get submitted to Work Comp for shoulder pain treatment.  And for these next 10, I ONLY submit to Work comp and I do NOT bill her insurance for these ones.  Do I have that all correct?  

Thanks again, Matt!  

You could still give a super bill for her regular medical insurance but not for her to turn into Work Comp. It would be easiest to start billing the 10 treatments moving forward to her Work Comp carrier then switch to her medical insurance if more treatments were needed. There is also a way you could bill both the Work Comp and medical insurance on the same day’s treatment IF you did two different treatments for the two different problems. It is not necessarily the way one would set the treatment up but as long as you are not billing both for an office visit or any other duplication and clearly note the two treatments were for the two different conditions that would not be double billing.

Matthew Bauer