FAQ: Workers' Compensation
I need to find out where to get information about my state's workers' comp law in regard to provider payment schedules. Can you direct me to a resource that would have that information about my state, as well as all other states? 
APTA's Workers' Compensation State Resource Guide includes links to payment policies, fee schedules and related information for all 50 states and the District of Columbia. This guide also provides contact information for each state's workers' compensation authority and information on how to get the latest news. This content will be updated as additional resources are identified.
For information comparing various states, Workers' Compensation Research Institute (WCRI) has two publications that compare the comp programs among states. Managed Care and Medical Cost Containment in Workers' Compensation: A National Inventory outlines the basics of every state's comp program, including whether a state uses a fee schedule (and on what that schedule is based) but does not actually list the fee schedules. Benchmarks for Designing Workers' Compensation Medical Fee Schedules looks more closely at the various fee schedules in particular, but still does not list the actual schedules.
Can we balance bill for unpaid workers' compensation claims? 
In short: no. Under the workers' compensation system the patient (or claimant) is not held responsible for their injuries and therefore, not held responsible for the bill. Illinois may be the only state that allows balance billing for workers' compensation claims. In the vast majority of cases, there should be no co-pay or deductible with workers' comp. (Some states have experimented with patient co-pays and deductibles under their workers' compensation statute such as Florida and Wyoming.)
If you have an issue related to your bills stemming from a patient's comp claim; your best tactic is to contact the workers' compensation commission in your state. They have procedures in place to assist you in resolving such issues.
How do I code a work hardening/conditioning program for my workers' compensation patients? 
CPT defines 97545 as "work hardening/conditioning; initial 2 hours." 97546 is used for each additional hour. 97546 cannot be utilized alone without 97545. If only one hour of care is provided, then it could be argued that you are not at the level of a work hardening/conditioning program. In that case, codes 97110 or 97530 might be appropriate.
97545 does not require direct one on one contact; however, CPT assumes that each person will have an "individualized" program to meet their needs. The Guidelines for Programs for Injured Workers (published by APTA), also does not note direct one-on-one contact. It does state that each program must be customized. Your treatment plan should be well supported by your objective findings during the examination and evaluation process.
Some fee schedules may require the use of local codes for work hardening and/or work conditioning. Check the state's fee schedule and payment rules to determine if they use 97545/97546 or local codes.
If you have specific questions on referrals and related regulations, it is best to check with the workers' compensation commission in your state.
Can a workers' comp patient voluntarily pay more for services than the fee schedule allows? 
Yes, although it would be highly unusual. Workers' compensation in all states except Illinois prohibits balance billing. As long as you and the patient understand that this is NOT balance billing and that he is NOT responsible for paying the balance, his direct payment to you (above the state's payment amount) is permissible. However, you might want to get a signed statement from the patient showing that he understands the arrangement. His out-of-pocket payments essentially become gifts.