Friday, September 21, 2012

NJ Balance Billing & NV Telemedicine - Modernization Towards Value

The New Jersey legislature took one further step towards modernizing the state's workers' compensation system when the Senate Labor Committee unanimously approved legislation yesterday that would ban medical providers from trying to collect the unpaid balances of disputed medical bills from injured workers, a practice known as balance billing.

The bill further provides that all medical disputes are the "exclusive jurisdiction" of the New Jersey Division of Workers' Compensation (DWC).

The bill, Senate 2022, is expected to win final approval by the New Jersey Senate next month and head to the desk of Gov. Chris Christie.

Supporters included a diverse group, , including the New Jersey State Bar Association, the New Jersey Business & Industry Association, the New Jersey Self-Insurer's Association, the New Jersey Advisory Council on Safety and Health and New Jersey Manufacturers Insurance Co., the state's largest workers' compensation carrier.

Missing from the bill is any language authorizing the creation and enforcement of a medical fee schedule, something that I consider necessary for the state's system to decrease incremental friction and increase efficiency.

Arthur Kravitz, past chairman of the Workers' Compensation Section of the New Jersey State Bar, told committee members at Thursday's hearing that DWC already has developed a separate system for resolving medical disputes.

The Senate, which adjourned this summer without addressing the balance billing issue, is scheduled to go back into session on Oct. 4.

Speaking of modernization, Nevada is leading the way for reimbursement schedules concerning "telemedicine."

Telemedicine is the remote provision of medical services which leverage high-speed, high-definition Internet capability. The promise is expanded and expedited care for injured employees in rural or remote areas.

Providing for telemedicine is a growing practice in the general health care industry but is still relatively rare in workers' compensation systems.

Charles J. Verre, chief administrative officer for the Nevada Workers' Compensation Section, told WorkCompCentral that his office is proposing the rule because of the population distribution of the state, with most people clustered in the metro area of Reno and Las Vegas and the rest scattered throughout a vast desert.

State officials expect telemedicine to add some costs, but those increases may be offset for the reduced need for injured workers to travel long distances for medical appointments.

The American Telemedicine Association, based in Washington, D.C., identifies 16 states that "have adopted mandates for the coverage of telemedicine," including four states that enacted such laws in 2012.

In an analysis of the impact of the proposal, the Nevada Division of Industrial Relations states that "creating reimbursement for telemedicine services may have an adverse effect on small businesses."

"A separate and substantial reimbursable item added to the medical fee schedule will likely increase costs to insurers that would most likely be passed along to employers," according to the analysis.

"The net cost increase is difficult to determine due to some degree of cost offset from anticipated decreased per diem costs."

The analysis notes, however, that injured employees would benefit from access to medical evaluation along with a distant treatment for a remote location.

While the change in the fee schedule to address reimbursement for telemedicine services "may have possible adverse effects on many small businesses in the short-term as insurers raise rates to pay for this new reimbursement," the analysis states, " may also generate long-term beneficial economic effects on small businesses due to increased longevity and productivity of injured workers who are able to return to work faster and spend less time off work traveling long distances for treatment."

While California dominated the news these past couple of months with massive changes to its workers' compensation system, New Jersey and Nevada are examples that more often than not modernization of workers' compensation moves along in a more gradual evolution towards finding the right balance and value proposition.

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