Electronic Health Reporter

Guest post by Tina Greene, senior regulatory affairs consultant, Mitchell International.

There are major healthcare regulatory mandates going in effect, at the federal and the state level, which will significantly impact property and casualty (P&C) insurance medical bills payers. The Administrative Simplification provisions of the Federal Health Insurance Portability and Accountability Act of 1996 (HIPAA, Title II), state mandates for property and casualty eBilling and more regulatory initiatives are forcing payers to understand these regulation’s requirements and be prepared to implement new processes and technologies in order to be compliant. Federal healthcare administrative simplification offers payers an opportunity to prepare for compliance while meeting cost containment and operational efficiency objectives, empowering property and casualty payers to prepare for an all-electronic American healthcare future.

The concepts of eBilling and ePayment for medical bills are gaining traction throughout the healthcare arena, along with the adjacent P&C insurance industry. Medical providers and P&C payers are increasingly taking advantage of the benefits associated with electronic billing and payments, which include substantially lower transaction costs, increased efficiency for call centers, adjusters and finance departments.

Non-legislative organizations are collaborating and recommending changes that could accelerate the impact on the P&C industry.

Other non-legislative organizations are collaborating and recommending changes that could accelerate the impact on the P&C industry. For instance, the Workgroup for Electronic Data Interchange (WEDI), the International Association of Industrial Accident Boards and Commissions (IAIABC), the American Medical Association (AMA), and the Accredited Standards Committee of the American National Standards Institute (ASCX12) are all working to ensure standards to facilitate eBill exchange and adoption. The National Committee on Vital and Health Statistics (NCVHS), a public advisory body to the Secretary of Health and Human Services (HHS), periodically holds meetings to review health statistics and trends. And while the NCVHS does not set policy, they do provide analysis, insight and recommendations to HHS, with eBilling as a topic of likely review in the future. These organizations have collectively laid a path for how to participate in this new environment.

Legislation mandates – P&C industry adoption

Over the past few years, there has been an increase in state legislation mandating eBilling, particularly for workers’ compensation medical bills. As more states contemplate these regulations, providers and P&C payers are facing a transition to eBilling for medical bills. While the transition may not be something everyone welcomes, there are certainly increased efficiencies that both medical providers and payers will be able to leverage.

Given all the changes in both the healthcare and P&C insurance industry, it’s imperative to stay informed. It’s likely that your organization will need to implement some new processes to accommodate these changes and take advantage of the increased efficiencies that result from the new regulations.