Langham: When Will Electronic Billing Come to Florida?

Wednesday, November 30, 2016 | 0

This fall, New Jersey joined the modern world of medical services, with a law requiring electronic medical billing. In the electronic age of smartphones, the internet, email and more, paper bills and envelopes remain the predominant business practice for medical billing. It is a topic that raises curiosity and questions. Why is the medical industry, otherwise so enamored with technology, mired in the 20th century?

Judge David Langham

In workers' compensation and other medical delivery systems, we consistently hear of the benefits of data. Data can be used to identify trends, make predictions, budget and manage limited resources. What if there were perfect access to perfect information? Of course that is not realistic. Perfection may be an admirable goal, but it is not attainable. However, there seems no reason not to pursue it nonetheless. If we pursue it, we will undoubtedly make progress toward a better process. 

Since I first wrote about electronic billing, I have had many discussions about its benefits and perceived costs. It became an ancillary topic in the National Conversation on workers' compensation last spring. What if we could do a better job of gathering and using information about injuries? If medical care providers submitted their billing electronically, and accompanied by a digital medical record of the treatment encounter, who would benefit?

If a process were created thoughtfully, it is likely that everyone could enjoy some benefit, although there would undoubtedly also be some measure of cost also. The providers and payers could reduce the costs of paper, envelopes, postage and more. The amount of time invested on both sides of this equation, creating paper billings and checks, printing and stuffing envelopes, and opening/processing on the other end is immense. 

In order for a medical provider to create a bill for services, data has to be entered into the computer. That data is then printed onto paper and transmitted across the country on trucks. When it arrives, someone has to open and straighten the document. The same data is then input into another computer, potentially with mistakes. The document then has to be scanned or filed. At some point the paper has to be shredded and recycled, and the process starts anew. It is a resource- and labor-intensive process. 

We have seen the electronic filing process benefit litigation. The claims for benefits, petitions or otherwise were prepared in some attorney's office, printed, mailed, opened, straightened and the data re-entered into another computer. In the microcosm of Florida workers' compensation litigation, we have witnessed the benefit of electronic filing. Attorneys and the state have saved millions of dollars in time, paper and postage by creating and then mandating the electronic filing process. 

There has also been a great deal of discussion of the potential for injured workers and their employers to have access to medical information. In the Social Security system, there is such access. If Florida developed a system for electronic submission of medical billing and records, such a database (or data "warehouse") could be easily included. Employees and employers could have timely access to treatment records, recommendations, restrictions, limitations, plans and more — a database that would likewise reduce costs for attorneys, employers, carriers and workers. 

WorkCompCentral reported that New Jersey joins the electronic billing states in 2016. It is, like many legislative actions, a law that illustrates compromises. It requires most medical New Jersey providers to submit bills electronically, with an exception for infrequent providers of workers' compensation services, those submitting "fewer than 25 bills per month." This compromise likely reflects the cost of training and equipment that will be required for the process. Allowing the small business/practice an exception makes sense. 

What does the medical provider get from the exchange? The easily identified benefits are listed above. But, this new law also provides a quid pro quo for adopting the modern process.

Under the New Jersey law, the electronically submitted billing has to be paid within two months. This makes sense. With the billing submitted electronically, the payers should be able to avoid significant work involved with interpreting that data and the data-entry or processing required for bill adjustment and payment. 

According to an earlier story on WorkCompCentral, New Jersey is the fourth state to mandate electronic medical billing. It joins an elite community with Minnesota, North Carolina and Texas. They are not the only states with electronic billing, but the only ones that require it. Six more states "have adopted an electronic medical billing framework for their workers' compensation systems" — California, Georgia, Illinois, Louisiana, Oregon and Washington. In all, 10 states lead the way to an inevitable future.

The Medical Society of New Jersey sought the exception for small practices submitting fewer than 25 bills per month but otherwise was supportive of the change. Its legislative affairs spokesman said that "the world is moving to electronic. We get that." And so, “we want it to move that way in order for claims to be processed more quickly. The concept is great."

There are concerns regarding the the involvement of "third parties, clearinghouses" and the potential processing costs to medical providers. The Medical Society says these costs are not inconsequential and over time can be expected to "add up," as "practices can send in hundreds of claims per day." But there is support nonetheless.

Despite the concerns and the potential costs, New Jersey legislatively joins an elite four. And while a total of 10 states offer the platform and evolve toward the new normal of electronic billing, Florida waits. The third most populous state in the union behind California (which permits electronic billing) and Texas (which mandates it), Florida waits, prints and mails. Carriers open, straighten, scan, file and repeat data entry. Doubtlessly, Florida will allow electronic billing and may require it. The question is when.

David Langham is deputy chief judge of the Florida Office of Judges of Compensation Claims. This column was reprinted, with his permission, from his Florida Workers' Comp Adjudication blog.