New California electronic medical billing regulations and revised paper medical billing requirements were released January 6th for public comment by California's Division of Workers Compensation (DWC). The regulations, part of the Division's 12-point plan to help control medical costs in California's workers' compensation system, will be signed into law in approximately 60 days. California now joins a growing number of jurisdictions encouraging electronic connectivity between providers and payers.
According to Jopari, for Payers to achieve the real benefits of the proposed regulations they will need to immediately assess their business automation and workflow processes, starting with whether their processes are capable of complying with the California dual processing requirements for processing paper as well as electronic bills.
The state's Paper bill processing requirements, which go into effect within the next few months, require many of the same front end edits, validation and back end adjudication processes as electronic bill requirements. Today most paper billing formats can be sent electronically. Payers that implement eBill strategies upfront instead of waiting 18 months later, will be able to take advantage of automating their paper processing, thereby significantly mitigating the cost associated with maintaining dual processing systems.
"Medical eBilling for workers' compensation between health care providers and payers has been evolving over the past 10 years," stated Steve Stevens, CEO of Jopari Solutions, a California based eBilling and ePayment solutions provider. "We have assembled over the past few years a growing network of providers and payers performing eBilling in virtually every jurisdiction. Jopari has established itself as a solutions leader in this important initiative by partnering with providers and their practice management and billing systems, leading clearinghouses, in addition to numerous payers and their bill review systems or managed care vendors."
The new regulations are a combined effort of the DWC in collaboration with providers, payers, technology suppliers, as well as industry trade and national standard organizations. They embrace the January 2012 HIPAA 5010 changes to the current 4010 electronic standards for exchanging medical information.
"Jopari is proud to have contributed to the development of these rules, and applauds the DWC for ensuring that they reflect the upcoming HIPAA 5010 standards changes," states Stevens. "Electronic commerce in the medical arena is a very well-established, high-profile topic, and is highly effective in improving provider/payer interactions, as well as streamlining billing/payment processes. Aligning with the existing and upcoming standards will greatly facilitate compliance. Jopari is prepared to assist providers and payers in California to meet these new regulations."
Stevens added, "With all of the change going on in healthcare, we strongly encourage providers and payers to get started now with establishing their eBilling plans. This will allow for a smooth transition from existing paper processes to the electronic process. There are many things to consider to fully optimizing the new requirements."
The modified proposal and additional information can be found at http://www.dir.ca.gov/dwc/DWCPropRegs/Ebilling/EBilling_Regulations.htm. Members of the public may comment on the revisions until 5 p.m. on Jan. 21, 2011.
Luminescence 96 Automate unveiled: Transforming luminescence analysis with automation