Re: Workers Comp

[Johnphelan]

Here's two cents more:

It is important to differentiate between workers' comp insurers and workers' comp providers in understanding the impact of HIPAA.

If a workers comp provider also sees an occasional non-worker's comp patient and electronically submits the bill or checks eligibility, etc., that provider becomes a covered entity and must observe all of HIPAA's rules.  Under HIPAA, these providers must meet minimal necessary requirements and can only submit information to wc carriers as permitted by law. Any information beyond that will require a patient authorization.  So these providers will need to be very clear on what is allowed under wc laws and what is not.

The workers' comp insurer is exempt from HIPAA for now but as the insurer seeks patient medical information, it is likely to receive greater provider kick back unless the insurer can clearly demonstrate that release of the information is permitted under the law or that the insurer has the patient's (that is, claimant's) authorization.

HIPAA's electronic transaction and coding standards could also contribute some chaos since worker's comp tends to do things differently (with its own codes, etc.).  Thus wc may become further out of sync as providers and billing services clean up their systems to match HIPAA's requirements.  Since worker's comp is still heavily a paper environment, however, the impact on electronic transactions may not be too great at the moment but time will tell.

I am curious if any providers out there have developed strategies that involve establishing some sort of walls between services to wc and non-worker's comp patients that they feel help mitigate HIPAA's impact on their industrial medicine services.

--John ---
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