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With the changes in the PPACA, the bill is no longer in the snail mail

In the United States the new-ish Patient Protection and Affordable Care Act (PPACA) is expected to have a big impact on the industry. It is a push from the regulators for wider use of e-billing. That explains the resounding theme throughout the set of new regulations that the provider and payer interactions need to become more efficient.

Workers’ compensation

Workers’ compensation (also known as workers’ comp in North America and compo in Australia) is a form of insurance that provides wage replacement and medical benefits for employees who are injured in the course of employment, in exchange for mandatory relinquishment of the employee’s right to sue his or her employer for the tort of negligence. (source: Wikipedia).

Paper in, paper out. Even today

The workers’ compensation world has long been regarded as one of the last holdouts to the continued use of paper bills, checks and explanations of reimbursement (EOR).

Even though many payers have invested in technology to create paperless claim environments, most continue to use paper conversion processes and print/mail facilities for check/EOR output. Paper in and paper out. The well known (but not always viable) reasons for this:

  • Including specific data elements (like claim numbers), attachments, and legally required payment-reason codes.
  • Some organizations are holding off until the state tells them to do so.
  • Scarce resources to implement e-billing.
  • Claimed technology challenges.
  • A change to the operating models could have a financial impact on either expenses and/or claim costs.

The e-effect of the PPACA

Even though some of the largest national and regional payers and provider groups are now making e-billing a standard part of their business operations. And even though reported successes, widespread adoption of electronic billing remains spotty.

It is expected that the PPACA will change all this.


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