Most hospitals that I encounter have at least a few Preferred Provider Organization (PPO) Network contracts that include workers’ compensation. Some have dozens. These contracts range from super simple 1-page Letters of Agreement, to massively complex multi-line managed care agreements. Hospitals typically devote staff to developing and managing these contracts, but just as is true with Group Health or Commercial contracts, work comp contracts have the same propensity for errors and abuse and left unchecked these blunders could cost hospitals dearly.
Medical billing reimbursement in Virginia has been a hot topic among industry pundits for years. As one of the few remaining “usual & customary” states where hospitals and physicians are not reimbursed at specific rates dictated by the state, the opportunity for creative interpretation of the rules has existed on both sides and bad actors have created a perfect storm for change. As a result, large gulfs between hospital charges and payments have generated thousands of disputes brought before the Virginia Work Comp Commission over the years and in 2015, the bubble burst.
December 6th Update: I've been getting lots of calls and emails about where Tennessee is with the 2018 e-billing mandate for work comp. Here is a quick update: Since the 11/30 deadline to file the rule was missed, we are in a slight delay window. The e-billing rule is currently with the Tennessee Attorney General's Office and is expected to be filed with the Tennessee Secretary of State anytime this month. Once that happens, there will be a 90-day run off before the rule becomes effective. Regardless, July 1, 2018 will be the go-live date for both PAYERS and PROVIDERS to be required to submit their work comp bills electronically. (The January 1 payer start date has been pushed to July 1 to align with the Provider start date). Message me with questions or concerns.
One of our major focuses at EnableComp is to monitor and report on legislative and industrial changes that have material impact to our business. As a national work comp revenue cycle company with over 600 hospital clients across the country, you can imagine that we (and the rest of the work comp community) have been watching Tennessee for quite some time as the changes within work comp have been significant over the past few years. Now with the State moving toward requiring work comp billing to be all-electronic in 2018, there are several points to consider for hospitals to be efficient and compliant with the proposed regulations.
When it comes to hospital billing priorities, work comp is often the last kid in line. Workers Compensation is complex, ever-changing, and it’s a fraction of your overall revenue. What most hospitals don’t really understand is that it is not that difficult to tame your work comp pay class, and be more profitable in the process. Here are five keys to success to consider for your billing office.