04/21/08
: WorkCompCentral News Website
By:
AUSTIN, Texas – Representatives of states leading the charge for electronic medical billing told a forum on e-billing Tuesday that efforts are underway to draft a model guidance for workers’ compensation systems throughout the country, drawing on the work already done in California and Texas.
Scarlette Gardner, assistant counsel for health policy with the North Carolina Medical Association, heads an International Association of Industrial Accident Boards and Commissions (IAIABC) committee working on the guidance. The model is intended to allow states to enact laws or regulations on e-billing that will allow their electronic billing requirements to mesh with systems used by national carriers, clearinghouses and e-billing operations, but with flexibility for local requirements.
Gardner reported on the initiative as member of a panel with representatives of California, Minnesota and Texas who discussed their e-billing initiatives at the IAIABC forum at Austin’s Crowne Plaza.
Todd Brown, regulatory consultant with Coventry and former executive director of the Texas Workers’ Compensation Commission, served as moderator for the panel.
Suzanne Honor-Vangerov, with the California Division of Workers’ Compensation's Medical Unit, reported e-billing was mandated by California lawmakers in 2004. Honor-Vangerov said regulators met initially with a small group of stakeholders, which expanded to more than 40, including health care providers, carriers and bill clearinghouses, with the effort requiring three years to “hammer things out.”
Providers are not required to use the system, but in California its use is encouraged as being more likely to result in timely payments to providers than paper-based billing, Honor-Vangerov said.
She said the California Medical Society “is buying into” the effort, noting that many doctors are experienced with e-billing requirements under Medicare. California has been attempting to match the format of its system as closely as possible to HIPAA requirements, she noted.
Honor-Vangerov warned the meeting that any e-billing approach that fails to recognize the investment of providers, carriers and other stakeholders in systems developed for health care billing likely will be doomed, comparing it to “building a beautiful playground on a toxic waste site.”
Allen McDonald, data information systems head for the Texas Division of Workers’ Compensation, reported Texas had “some false starts” with its e-billing efforts but has been moving to resolve those problems.
One problem was developing the rules and guidelines, “not everybody was at the table" during the process, McDonald said.
Workers’ compensation carriers and attorneys showed up, but providers, clearinghouses and billing companies were less engaged in the initial efforts, he said.
McDonald reported the agency has made changes in its efforts to refine the billing process, which Texas lawmakers have mandated. Requirements for providers and carriers to be able to exchange billing information take effect on Jan. 1.
McDonald noted one problem which the division hadn’t anticipated was the volume of unsolicited documentation which some providers have been sending with their e-bills.
That appears to be a holdover from the paper system, with doctors being accustomed to “making copies of everything” to be sent to carriers, even if all the documentation isn’t needed, McDonald said. Such documentation may be filed by fax or e-mail under the division’s rules, he noted.
McDonald reported stakeholders are working on alternatives for submitting or accessing documentation as needed, including use of portals to allow electronic filling or permitting access to records on a secure website.
Stakeholders also are working on ways to assure that documentation is matched to the proper bill, McDonald said.
“From a technical standpoint, there are a number of solutions,” he reported.
Scott Brener, vice president and general counsel for SFM Companies and former commissioner of the Minnesota Department of Labor and Industries, reported Minnesota’s foray into e-billing came last year as the result of language placed in the state’s biennial budget bill with the support of hospitals.
The Department of Health is dealing currently with implementing the requirements, which “much broader than just workers’ compensation,” Brener said. How to fit automobile insurers into the system is one of the issues being worked on, he reported.
“Our company is committed to e-billing,” Brener said. SFM specializes in workers' compensation coverage and services in Minnesota and Wisconsin.
Gardner said North Carolina is in the early stages of developing e-billing requirements, which she is working on for the medical society and IAIABC.
One thing that has been determined is that there cannot be separate billing systems for workers’ compensation and group health, Gardner said.
The drafting effort is looking at political and practical goals, including issues such as timely payment, data transmission and data reporting issues, she said. The effort intends “to leave everything as general as possible,” to allow for market solutions to problems and to create a model that can be used widely, Gardner explained.
McDonald and Honor-Vangerov agreed that e-billing also should, in the long term, lead to “cleaner” data that will assist regulators in fine-tuning e-billing.
They also agreed that recognizing economic interests and working with stakeholders, rather than imposing regulations, are the keys to the eventual success of e-billing.
“You can’t make this happen by assessing fines,” McDonald concluded.
--By Bill Kidd, WorkCompCentral Central Bureau Chief
billkidd@texas.net
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