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L&I FAQSGuidelines and Reimbursement
GUIDELINES ON TREATING WORK RELATED INJURIES
MEDICAL MANAGEMENT
Minimize use of opiates Prompt return to work is encouraged Convey work restrictions to the
patient’s employer Refer to Occ. Medicine clinic for follow
up Prompt follow up encouraged,
especially if time off
ADMINISTRATIVE CONSIDERATIONS
Patient fills out Report of Accident (ROA) and signs
Provider complete as much as possible Sign and date form Complete Activity Prescription Form (APF)
form Registration faxes formNot completing/faxing form rejects and/or delays care which correlates in poorer outcomes and increased disability!
FORMS
Report of Industrial Injury or Occupational Disease
If you think the work injury is related to work on a more probable than not basis (more than 50% probability, you should mark “probably” or “yes” (blue section, box 7). If you think the injury is not related to work mark “no” or “possibly”.
APF FORM
APF FORM
Filled out and submitted with initial ROA
This info is in the middle of the APF form.
Document whom you called, what was discussed (work restrictions and duration of restrictions) and the time it took
HIPAA
REIMBURSEMENT
APF Form $50.82 Telephone call with employer
$23.43 – 66.78
Report of Accident (L&I form) Within 2 business days $58.65 Within 3 - 5 days $39.10 Within 6 – 8 days $29.10 More than 9 days $19.10
• Rates from July 2014 COHE Fee Schedule on www.lni.wa.gov
COHE
1. View the Enrollment webinar. http://www.chifranciscan.org/Health-Care-Services/COHE/Resources/
2. Complete the Enrollment quiz.http://www.chifranciscan.org/Health-Care-Services/COHE/Resources/
3. Complete the COHE provider application (see attached) email completed form to the COHE Alliance of Western WA and cc Laurel Green…
TALKING POINTS WITH PATIENTS
Activity helps you recover Some discomfort is normal when
returning to activities after an injury You can help with your own recovery You can protect yourself from re-injury Early and safe return to work makes
sense
SUMMARY
L&I paperwork is vital to ensure quality patient care
Registration key in facilitating and forwarding claims
APF form does exist and should be clipped to all forms for completion
3 opportunities for reimbursement, up to $175+ per claim
Document in EPIC that you completed ROA, APF and +/- call to supervisor
