Question

A patient presents to the provider's office with a complaint of a migraine. The patient has Medicare and Medicaid. The patient also has a Worker's Compensation claim with a diagnosis of head injury. After the provider assesses the patient, the final diagnosis is a concussion. Where should this claim be submitted first?

A. Medicare
B. the patient's employer
C. Worker's Compensation
D. Medicaid

Answer 1

The claim should be submitted first to Worker's Compensation since the final diagnosis is a concussion which is related to the patient's work injury. If additional coverage is needed after Worker's Compensation, Medicare and then Medicaid would be considered.

Step-by-step explanation:

The correct answer to where the claim should be submitted first is Worker's Compensation (C). When a patient's condition is related to a work injury, as indicated by the diagnosis of a concussion which is potentially associated with the Worker's Compensation claim, the appropriate first course of action is to submit the claim to Worker's Compensation. This is because Worker's Compensation is a form of insurance specifically designed to cover injuries that occur in the workplace or as a result of work-related activities.

If the Worker's Compensation claim is denied or does not cover all of the expenses, then the provider could look into billing secondary insurers, such as Medicare or Medicaid. Medicare would next be considered for individuals over the age of 65 or with certain disabilities, followed by Medicaid, which supports low-income individuals who meet specific eligibility criteria.