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With the PPACA Changes, the Bill Is Not in the Mail

With the Patient Protection and Affordable Care Act the insurance industry is being moved, sometimes reluctantly, into making provider and payer interactions more efficient.

By Don St. Jacques | Updated on July 14, 2011

There are many theories circulating among the various workers’ compensation blogs, newsletters, and websites regarding the impact that the Patient Protection and Affordable Care Act (PPACA) will have on the industry. Often mentioned is that the need to make provider and payer interactions more efficient is a resounding theme throughout the set of new regulations. Medical billing and the ultimate reimbursement processes have become a particular focus by the American Medical Association and numerous regulators.

The workers’ compensation world has long been regarded as one of the last holdouts to the continued utilization of paper bills, checks and explanations of reimbursement (EOR.)  The rationale emanates from the nuances of workers’ compensation, including specific data elements (like claim numbers), attachments, and jurisdictionally required payment-reason codes. Even though many payers have invested in technology to create paperless claim environments, most continue to use paper conversion processes and print/mail facilities for check/EOR output. In essence: paper in, paper out.

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