Are You Ready Slide Deck 2014-06-19

8/17/2019 Are You Ready Slide Deck 2014-06-19

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North Carolina Workers’ Compensation eBilling Overview

Are you ready? June 19, 2014

Conor Brockett – Associate General Counsel, North Carolina

Medical Societyon St! Jac"ues – S#$ % Business e&elo'(ent, Jo'ariSolutions, )nc!


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North Carolina eBill and EFT - Agenda

• North Carolina eBilling Overview and Terminology

• Industry Approach

• Regulations recap• How to get started

• References


3/25

Announce(ent *e+ardin+ lectronic Medical Billin+

and $ay(ent

Pursuant to N.C. Gen. Stat. §97-26(g1), the Industrial Coission !as dire"ted toado#t rules re$uiring ele"troni" edi"al %illing and #a&ent #ro"esses. 'he IndustrialCoission su%se$uentl& ado#ted le"troni" illing *ules 1+1-1+9 in 2+12. 'heserules !ere then held in a%e&an"e in "onun"tion !ith other rule aing eorts and toallo! the Coission to de/elo# an i#leentation guide. 'he le"troni" illing and

Pa&ent Co#anion Guide is no! in 0nal or and read& or #u%li"ation. Cli" here ora""ess to the guide. 'his guide "an also %e a""essed on the Coissions !e%#agesor Carriers and or 3edi"al Pro/iders..

'he date or i#leentation o ele"troni" edi"al %illing in the ado#ted rulesreeren"ed a%o/e is 3ar"h 1, 2+14. 'he Coission re"ei/ed and "onsidered eed%a"and ulti#le re$uests or e5tensions o the 3ar"h 1, 2+14 deadline ro e#lo&ers,"arriers, third-#art& adinistrators, and edi"al %illing "o#anies. In order to allo!

these staeholders additional tie or #re#aration, the Coission !ill not re$uire"o#lian"e !ith the le"troni" illing *ules until July 1, 2014, !ith regard toele"troni" edi"al %illing #ro"esses. 'he rules and #ortions o the "o#anion guidethat go/ern and re$uire ele"troni" edi"al #a&ent #ro"esses !ill not %e andator&until January 1, 201-. No additional e5tensions !ill %e granted..

htt#!!!.i".n".go/ed#ro/iders.htl

http://www.ic.nc.gov/medproviders.htmlhttp://www.ic.nc.gov/medproviders.htmlhttp://www.ic.nc.gov/medproviders.htmlhttp://www.ic.nc.gov/medproviders.htmlhttp://www.ic.nc.gov/medproviders.html


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Terminology

• eBilling – the process of submitting Workers’ Compensation medical billing

and related documentation electronically to payers, as well as receiving

acknowledgements and remittance information.

• !T "electronic funds transfer# – the ability of a payer to directly depositpayments for medical bills into a provider’s designated bank account. Requires

enrolling with a payer to supply banking information.

• eBilling agent – a specialized clearinghouse partner that assists providers

and payers with their Workers’ Compensation connectivity, along with

providing !" enrollment capabilities for multiple payers.


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Terminology - contined

• Remittance Advice ")*+# – an electronic feed of information from the payer to

providers to advise whether a bill has been paid or denied, by what method,

how much, and reasons on a line(by(line basis for paid$denied. )t contains

much of what is on a typical #planation of Reimbursement *+R, but often

not some of the specific messaging. "he -/ is designed to allow automaticposting into the 012$RC2 or Clearinghouse, provided it has been enabled

with the capabilities to import them.

• Companion ,uide – the details of how e'illing is to work, including formats3

timelines3 responsibilities of provider, payers, and agents. "he &C Companion

4uide is available on the )ndustrial Commission website at http5$$ www.ic.nc.gov$ncic$pages$'0Cguide.pdf

http://www.ic.nc.gov/ncic/pages/EBPCguide.pdfhttp://www.ic.nc.gov/ncic/pages/EBPCguide.pdfhttp://www.ic.nc.gov/ncic/pages/EBPCguide.pdfhttp://www.ic.nc.gov/ncic/pages/EBPCguide.pdf


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Terminology - contined

• Trading &artners – are entities that have established 6) relationships and

that e#change information electronically either in standard or mutually agreed(

upon formats. "rading 0artners can be both 2enders and Receivers,

depending on the electronic process involved *i.e. 'illing or 7cknowledgment.

• Trading &artner Agreement – a written agreement that defines the methods,

formats, and responsibilities of each party e#changing data, including Claims

2ubmission, 7ttachment !ormats, 7cknowledgements, delivery of lectronic

Remittance 7dvices, 0ayment 1ethodology, access to 0ortal 2ervices,

"ransmission 1ethods, and 0rocessing rules.


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-or.ers/ Compensation Industry approach to eBilling

• 0tili1e the same technology platform"s# and wor.flow"s# that a provider

uses today to process all other lines of insurance

• 0tili1e the same HI&AA transaction sets as group2commercial claims to

ena3le connectivity solutions to move -C transactions4• 72C 89: 2tandards for lectronic 6ata )nterchange "echnical Report "ype, ;ealth Care

Claim *-< ( 0rofessional, )nstitutional and 6ental

• 72C89: 7cknowledgments * ===, "79, :


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-or.ers/ Compensation Industry approach to eBilling

• +verall, streamline the process and eliminate unnecessary steps and paper

• Clean data on the front end results in $straight through% processing on the

back end ? reduces 7ccounts Receivables, need for follow(up calls, improves

coordination with the claims ad%uster


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Ste' 16 0rovider utilizes their e7isting 0ractice 1anagement2ystems, 'illing 2ervices or Clearinghouses to electronically submit

claim data *-


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North Carolina reglations

• &orth Carolina is the latest state to %oin a growing number of %urisdictions that

requires Workers’ compensation providers and payers to e#change medical

billing$payment information electronically.

• "he &orth Carolina rules are based on a nationally adopted framework using

standard transactions created by the )7)7'C, which is the trade association ofWorkers’ Compensation %urisdictional authorities. *)n &C, this the )ndustrial

Commission

• "he rules were prepared by a consensus group with input from the medical

and payer communities.

• "he rules layout both the formats, responsibilities of each party, as well asoperating timelines.


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North Carolina reglations ! con’t"

• :uly ;5 9


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Timelines

• 0rovider 2tatute "ime "o 2ubmit a 'ill ? => days from date of service

• 0ayer e'ill 0ayment "imeline ? > days from receipt of clean bill

• Remittance 7dvice "imeline ? > days from receipt of clean bill

• )ncomplete !ile Re%ection "imeline *=== ? 9 business day

• )ncomplete 'ill Re%ection "imeline * :


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Timelines

• Complete 'ill 1issing Claim &umber 0ending "imeline Rules ? / days

• Complete 'ill 1issing 7ttachment 0ending "imeline Rules ? / days

• 6uplicate 'ill 2ubmission "imeline from date of R7 notification ( @> days

• Reconsideration$ 7ppeal "imeline date of R7$0ayer final decision ? > days


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Bene#its o# eBilling

• liminates paper distribution processes

• stablishes electronic audit trail

• dits ensure that a complete bill package is delivered to the payer, reducing

re%ects for incomplete or missing data$attachments

• )f your practice can accept an -/, it should assist in posting and reconciliationprocesses

• "ypically providers see big improvements in their 7$R metrics, fewer follow(up

calls, and reduced need to resubmit billsA

>This may not 3e the case for all payers


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$ost common methods availa%le to tili&e eBilling

• 'irect eBill &ortal – an option for providers that may not readily have access

to be able to generate or send transactions via their system, or are low volume

WC. 7llows for entry of billing data and use of an upload of 06! or ")! images

or fa# server for attachments. "hese 0ortals allow for online correction,

viewing error messages or re%ects from payers, and viewing of Remittance7dvice *-/ information.

• Online &ortal 0ploads – allows practices that can create billing files on their

system to upload -< or other formats to a portal when they cannot establish a

link to a payer or e'ill agent. 7ttachments can also be uploaded, either

individually or in batches, or also use a fa# server. 0ortal is used for viewing

errors and retrieving Remittance 7dvice *-/ information.


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$ost common methods availa%le to tili&e eBilling

• 'I interfaces ( billing and attachment files are sent securely between the

012$RC2 or Clearinghouse and the payer or e'ill agent. 7cknowledgments, error

messages, and Remittance 7dvice *-/ information is e#changed electronically. "his

method requires some effort to get set(up and test, but for volume users this is the

most efficient model. *2imilar to the process for 4roup and Commercial payers.• Attachment 8olutions – !le#ibility for "rading 0artner 7greements to include

such methods as secure electronic fa#, secure encrypted email, or electronic

transmission using the prescribed format 72C 89:&$>>/>9>8:9> Additional

Information to Support Health Care Claim *:


19/25

EFT ! coming '('()*'+

• Traditionally, payments for medically-related services by WC

payers is to issue paper checks and Explanations of

Reimbursement E!R" via the #$%$& %roviders often manually

post the information in their systems&

• 's of (-(-)*(+, the Centers for edicareedicaid $ervicesC$" re.uired /roupCommercial payers must offer providers

the ability to enroll for and be paid via E0T& ' set of !peratin1

Rules for E0T and ER' have been issued by C'23C!RE

4hich further define ho4 providers and payers interact&

• The Workers5 Compensation industry is also no4 adoptin1 theuse of E0T&


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EFT ! coming '('()*'+

• What to e,pect

– 6ust like in the /roup market, you 4ill likely have to enroll

4ith each payer&

– There 4ill be some e7ill solutions that 4ill offer E0T

enrollment across multiple payers


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.ow to get started

• ?i.e any 3usiness pro3lem5 you need to have some 3asic information to

find the right solution for your practice

– ;ow much WC do you handleB &umber of bills per month, billed, 7$R and 62+

attributed to WC, ma%or payers you bill, and specific practice needs

• Contact your &ractice or Revenue Cycle @anagement 8ystem supplier53illing service5 or Clearinghouse

– 7sk them if they have WC e'illing capabilities, and who they are connected to as

far as e'ill agents. 'e sure that they can get you to the ma%ority of your key payers

• Be sure you understand any contracting5 upgrades5 or costs associated

with getting started


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.ow to get started - more

• 'espite the mandate5 you need to 3e ready that not all employers2payers

will 3e ready on 2;5 and even for sometime after that

– Dou may still need to send some bills via paper. 1any WC solutions and e'ill

agents do offer 0rint E 1ail capabilities so that you can make the workflow

changes once, but you need to assess any costs to be sure it is the right strategyfor your practice.

• 'ecide on the solution and get implemented

– !or some solutions it may be a matter of days, for others there could be significant

lead time, contracting, and$or add(on modules to buy.

• Train your staff5 monitor your results – "his is a change of process, so you need to stay focused to ensure the right results


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0e#erences

• North Carolina Industrial Commission http422www6ic6nc6gov2medproviders6html

– NC -or.ers/ Comp (3ill Companion ,uide www6ic6nc6gov2ncic2pages2B&Cguide6pdf

• North Carolina @edical 8ociety http422www6ncmedsoc6org

• American @edical Association – &roperty Casualty Tool.it

http422

www6ama(assn6org2ama2pu32advocacy2topics2administrative(simplification(initiatives2electroni

c(transactions(tool.it2wor.ers(compensation6page

• -'I &roperty Casualty -or.group – eBill ducational Resource

Toolshttp

422www6wedi6org2wor.groups2transactions(code(sets2property(casualty(electronic(medical(3ill

("e3ill#

• :opari 8olutions5 Inc6 www6opari6com

http://www.ic.nc.gov/medproviders.htmlhttp://www.ic.nc.gov/ncic/pages/EBPCguide.pdfhttp://www.ncmedsoc.org/http://www.ama-assn.org/ama/pub/advocacy/topics/administrative-simplification-initiatives/electronic-transactions-toolkit/workers-compensation.pagehttp://www.ama-assn.org/ama/pub/advocacy/topics/administrative-simplification-initiatives/electronic-transactions-toolkit/workers-compensation.pagehttp://www.ama-assn.org/ama/pub/advocacy/topics/administrative-simplification-initiatives/electronic-transactions-toolkit/workers-compensation.pagehttp://www.wedi.org/workgroups/transactions-code-sets/property-casualty-electronic-medical-bill-(ebill)http://www.wedi.org/workgroups/transactions-code-sets/property-casualty-electronic-medical-bill-(ebill)http://www.wedi.org/workgroups/transactions-code-sets/property-casualty-electronic-medical-bill-(ebill)http://www.wedi.org/workgroups/transactions-code-sets/property-casualty-electronic-medical-bill-(ebill)http://www.jopari.com/http://www.jopari.com/http://www.wedi.org/workgroups/transactions-code-sets/property-casualty-electronic-medical-bill-(ebill)http://www.wedi.org/workgroups/transactions-code-sets/property-casualty-electronic-medical-bill-(ebill)http://www.wedi.org/workgroups/transactions-code-sets/property-casualty-electronic-medical-bill-(ebill)http://www.wedi.org/workgroups/transactions-code-sets/property-casualty-electronic-medical-bill-(ebill)http://www.ama-assn.org/ama/pub/advocacy/topics/administrative-simplification-initiatives/electronic-transactions-toolkit/workers-compensation.pagehttp://www.ama-assn.org/ama/pub/advocacy/topics/administrative-simplification-initiatives/electronic-transactions-toolkit/workers-compensation.pagehttp://www.ama-assn.org/ama/pub/advocacy/topics/administrative-simplification-initiatives/electronic-transactions-toolkit/workers-compensation.pagehttp://www.ncmedsoc.org/http://www.ic.nc.gov/ncic/pages/EBPCguide.pdfhttp://www.ic.nc.gov/medproviders.htmlhttp://www.ic.nc.gov/medproviders.html


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@uestions

A 'he North Carolina 3edi"al So"iet& al!a&s !el"oes $uestionsa%out the eilling transition or a%out 0nding an eillingsolution.Please "onta"t Conor Brockett at (919) B-B6 or

Cro"ettDn"edso".org.
mailto:[email protected]:[email protected]

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Are You Ready Slide Deck 2014-06-19