Medical group supports model rule for medical electronic billing

Physicians, employers, insurers, and state governments will benefit from electronic processing of medical claims in the workers' comp system, according to the American Medical Association.

The group announced its support for a model state regulation to encourage states to adopt electronic billing.

The model rule, developed by the International Association of Industrial Accident Boards and Commissions, is a template for jurisdictions to develop their own rules. It calls for adopting a nationally recognized set of uniform standards to guide electronic billing in the workers' comp system.

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The AMA cited an insurance industry study saying the cost of processing an electronic medical claim is 46 percent lower than processing a paper medical claim. "Streamlining the exchange of claims and billing information will reduce administrative costs and paperwork while generating savings that can help stabilize workers' compensation premiums," said Dr. Steven J. Stack, AMA chair-elect.

California and Texas have adopted rules based on the IAIABC model, according to the AMA, while Georgia, Louisiana, North Carolina, and Oregon are moving toward adoption.

The submission of electronic medical bills is not required under the Health Insurance Portability and Accountability Act, according to the IAIABC.

"Given the differences in certain data requirements between the health industry and workers' compensation ... automated systems designated for health-related transactions may not meet all the data needs for workers' compensation bill submission," the model rule states. "As such, jurisdictions need to decide how their framework will be applied and how to address the health care provider requirements related to electronic transactions. The key question that must be answered by the jurisdiction is whether to mandate health care providers to submit workers' compensation medical bills electronically, to provide incentives to health care providers for the electronic submission, or to simply permit the submission of electronic bills."

Read more at the WorkersComp Forum homepage.

May 31, 2012

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