OHR offering electronic workers’ comp billing
In a move that will enable it to offer electronic billing services for clients involved with workers’ compensation, Skowhegan, ME-based Occupational Health Research (OHR), a leading provider of software and services for occupational medicine professionals, has entered into a long-term agreement with eStellarNet Inc. of Concord, CA.
eStellarNet provides the property and casualty industry’s transaction hub for medical transaction processing. This hub will now enable comprehensive payer connectivity services to 500 occupational health facilities currently using OHR’s SYSTOC software, serving more than 150,000 corporations in 46 states. There are two versions of SYSTOC currently in the field, notes Ken Martin, vice president of customer solutions for OHR. The 6.x version, which operates in a DOS environment, is used by 65% of OHR’s clients and is the version that is currently compatible with eStellarNet. It is anticipated that compatibility with the Windows version will be achieved later this year.
"We’ve had clients asking for this type of technology for a long time," says Martin. "There have been ongoing problems with billing. If you come out of the hospital environment as an end-user, you’ve been able to do electronic billing to Medicaid and Medicare for years. In fact, Medicare has announced that soon it won’t accept paper at all. The problem is that the workers’ comp insurance payer typically requires more documentation about claims than Medicare does, for example, about an urgent care claim. They want to know if the employee is able to do work, to perform light duty, if the diagnosis is related to the accident, when they might be able to come back to work, and so on."
A logical fit
The OHR/eStellarNet partnership makes sense, Martin notes, because both organizations are specialized. "The beauty of SYSTOC is that it is designed for the occupational health clinics," he notes. "The problem has been that electronic claims submissions have not been designed to handle workers’ comp claims. But eStellarNet serves the same niche we do; it is designed for workers’ comp electronic claims."
Sophisticated workers’ comp billers know that if they want to keep their AR (accounts receivable) down when they send out their billing, it’s critical to make sure the progress note goes with it. "What you generally find, however, is that half of the occupational health clinics don’t do this, or they don’t even have transcribed notes; they have hand-written notes," says Martin.
The transaction hub electronically "clips" all the required attachments to the bills and batch-delivers them within 24 hours. "That is huge," Martin asserts. "What is being clipped on is the medical record that will ensure the bill will be paid." The way the new system works is through what Martin describes as a "two-way data dump."
The day-to-day SYSTOC customers don’t really do anything very different; they enter their workers’ comp bill, which has payer IDs in the system that indicate the use of electronic claims.
"However, often when they drop the bills SYSTOC has all the billing information, the medical transcription as well as work restriction information, and a host of other things," Martin explains. "Whenever the clients drop their bills, the workers’ comp bills kick out and the paper claims kick out behind them; then, they are collated and mailed out in paper form. But eStellarNet will do the same thing on the computer screen. You just press the process bill’ button; it drops out an electronic copy of all that information, and it is sent to eStellarNet. [The company] lets you know within 24 hours if there are any critical omissions, so you can fix and resubmit the claim. We also can set up a direct deposit into their account."
Be careful what you send
Because everything that is sent electronically will be seen by the insurance carrier, users must be careful about what they include in their claims submissions, Martin advises. "There’s a mindset that says insurance carriers should not be privy to all of this information, and that’s true to some degree," he concedes. "Clinics need to be conscious of the fact that workers’ comp insurance carriers really only should be privy to information pertinent to that claim. If a worker got a nosebleed because he was hit by a 2 x 4’ and he happens to be a diabetic, the two are not related and the information about the diabetes is not pertinent to the claim. Doctors and medical managers need to be careful not enter nonpertinent information in places where SYSTOC will automatically attach it to the bill. Some users don’t want to deal with this, and say they will only give the payer the information as they ask for it; the price they pay is that their AR will take longer."
And that is the key benefit of electronic workers’ comp bill paying. "It’s not so much that it will reduce administrative costs," notes Martin. "But it clearly will reduce administrative headaches. If you’ve ever walked into a clinic that sees between 50 to 100 patients a day on the day they drop their bills, it’s a nightmare. They have stacks of paper everywhere that they have to collate. Through eStellarNet, you are basically saving headaches and improving efficiency."
[For more information, contact: Ken Martin, OHR, P.O. Box 900, Skowhegan, ME 04976. Telephone: (800) 444-8432.]
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content