For orthopedic, occupational medicine, pain, and primary care practices across industrial Texas, workers’ compensation is real revenue — and a recurring disappointment, because comp claims run under Division of Workers’ Compensation (DWC) rules that punish commercial-insurance habits. The same five mistakes appear wherever we audit comp-heavy AR.
1. Incomplete Claim Identification at Intake
A comp claim needs the employer, carrier, claim number, adjuster, and date of injury — captured at the first visit or chased for months afterward. Front desks trained for insurance cards routinely miss half of it, and every missing element is a billing delay with a phone tree attached.
2. Skipping Preauthorization on Listed Services
DWC rules define services requiring preauthorization; providing a listed treatment without it generally forfeits payment, with appeal paths far narrower than commercial habit assumes. The preauthorization list belongs in the scheduling workflow, not in the biller’s memory.
3. Expecting Charges Instead of Fee Guidelines
Comp pays per DWC fee guidelines — largely Medicare-based methodologies with system-specific rules — regardless of billed charges. Practices that never verify payments against guideline calculations cannot tell correct payment from underpayment, and comp carriers are not above the occasional miscalculation.
4. Missing the Dispute Deadlines
Fee disputes and medical-necessity disputes each follow defined DWC processes with strict windows. The system is genuinely rules-based: file properly and on time, and the rules protect you; drift past the window, and no amount of being right recovers the claim.
5. Not Screening for Non-Subscribers
Texas allows employers to opt out of comp entirely. A non-subscriber’s injury case follows the employer’s occupational benefit plan or liability paths — completely different billing mechanics that intake must identify on day one, not discover at denial.
The Fix Is a Parallel Workflow
None of these mistakes reflect difficulty; they reflect running comp through the wrong pipeline. The practices that capture comp revenue reliably run it as its own workflow — comp-specific intake fields, the preauth list at scheduling, guideline-verified posting, and dispute deadlines docketed like the assets they are. In refinery country, that workflow pays for itself with the first properly disputed underpayment.