patients in Texas must be able to bill electronically by
January 1, 2008 or file for an
exemption waiver by
October 31, 2007. This is a helpful guide for
physicians to determine what action steps to take to meet
the electronic billing requirements.
If you
have read this far after seeing this piece is about workers’
compensation, then more than likely workers’ compensation
patients are a part of your practice. The first logical step
is to determine if you meet the criteria for a waiver from
the requirements to bill electronically. Even if you meet
the requirements for a waiver, there are certainly
advantages to billing electronically, like a reduction in
administrative burdens with electronic acknowledgements that
bills were received. Other benefits include streamlined bill
processing and a reduction in billing and coding errors.
For
those physician offices that may not be required to bill
electronically, you must qualify for an exemption by filing
a waiver with the Texas Department of Insurance – Division
of Workers’ Compensation. Waivers are available to
qualifying entities based upon two justifications:
· Small
practice – physicians that employ ten or fewer employees and
workers’ compensation accounts for less than 10% of their
practice; and
· Financial
burden - physicians that can substantiate that implementing
electronic billing presents an unreasonable financial
burden.
The
deadline for submitting a
waiver request to the Texas Department of Insurance,
Division of Workers’ Compensation (TDI) is
October 31, 2007.
For
those physicians who are required to bill electronically,
physicians are responsible for establishing their own
business relationships for e-billing. Whether you bill
internally or externally with a billing service company, a
contractual relationship must be established with an
e-billing clearinghouse for workers’ compensation claims. If
your billing is done externally, you should ensure that your
service company is prepared for e-billing for your workers’
compensation claims.
Need
help here, what do physicians who bill internally need to
know?
TDI
will provide a comprehensive list of insurance carriers and
federal employer identification numbers (FEINs) for those
insurance carriers on the TDI website. The FEINs can be used
by physicians when submitting an electronic bill. TDI also
will provide names and identification numbers for insurance
carrier agents/clearinghouses provided by the insurance
carriers.
Physician offices need to prepare for the requirements and
deadlines of e-billing in worker’s compensation. Some of the
administrative hassles and burdens that plague the workers’
compensation system will be reduced with electronic billing
and reimbursement. With the proposed rules to increase the
medical fee guidelines in workers’ compensation and the
adoption of e-billing, delivering care to injured workers in
the workers’ compensation may be improving. After all, it’s
about time.
