Big changes are coming to our workers’ compensation system. To help physicians and their practices understand and adjust to these changes, the North Carolina Medical Society (NCMS) has created a new webpage, Workers’ Comp: Information for Physicians. There you will find a physician’s guide to House Bill 709, along with other resources, helpful links, and news from the Industrial Commission.

Make the NCMS Workers’ Comp webpage your source for the latest news and resources as the NCMS Workers’ Compensation Task Force continues its long-standing mission to improve how doctors of all specialties treat injured workers and interact with the workers’ compensation system. NCMS Past President Richard Bruch, MD, chairs the Task Force, and Keith Kittelberger, MD, serves as Vice Chair.

The NCMS played a key role in the negotiations that led to the enactment of HB 709 – Protect and Put North Carolina Back to Work. This workers’ comp reform bill addressed many issues important to physicians, such as second opinions, independent medical exams, and access to medical information by employers. The law also directed the Industrial Commission to adopt rules that will require electronic billing and payment, standardize the medical documentation that accompanies claims to carriers, and require carriers to accept 5010 transactions and ICD-10 diagnosis codes.

NCMS members may contact the Member Resource Center with questions about workers’ compensation at kfreeman@ncmedsoc.org or by calling 800-722-1350.

See related Bulletin articles:

NC Industrial Commission Delivers on E-Billing and Electronic Payment in Workers Comp (6-17-11)

NCMS Efforts to Secure E-Billing Mandate in Workers’ Comp Gets National Attention (11-4-11)

Federal money waits to be used by N.C., 11-11-11, The News and Observer

Staff Writer Lynn Bonner reports on the status of federal money that is earmarked for the state’s health benefit exchange.

Diagnosticians run higher malpractice risk, 11-3-11, United Press International

UPI story reports that research shows diagnostic physicians may be at higher malpractice risk due to communication failures among doctors.

A doctor’s vision for Medicare, 11-7-11, The News and Observer/MCT Information Services

An op-ed by H. Gilbert Welch, MD, professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice. It originally ran in the Los Angeles Times.

Test for Hospital Budgets: Are the Patients Pleased?, 11-7-11, The New York Times

Writer Jordan Rau reports on the Medicare program’s new effort to take patient satisfaction into account when reimbursing hospitals.

Unreliable cord blood banks could endanger kids, 11-09-11, CBS News

Investigative reporter Ginger Allen reports that some blood banks that store a child’s cord blood have proven unreliable.

Work injuries low in North Carolina, 11-10-11, The News and Observer

Staff Writer John Murawski reports that the state’s workplace injury rate fell to a record low in 2010.

This week, internet-based news service WorkCompCentral.com® published an article about the North Carolina Industrial Commission’s and the General Assembly’s recent actions to require electronic billing and payment processes in the workers’ compensation system. The article highlighted the efforts of the North Carolina Medical Society as a driving force behind this development.

In June the Industrial Commission voted to require insurance carriers and providers to develop and implement electronic billing and payment processes, a decision long sought by the NCMS. Less than two weeks later, the Governor signed HB 709, a workers’ compensation reform bill that directed the Industrial Commission to issue rules on electronic billing and payment.

Author Mike Whiteley’s article notes that only a handful of other states have mandated the use of electronic filing and payment in the workers’ compensation system. The NCMS will continue to work closely with the Industrial Commission as the rulemaking process gets underway. We will provide updates on activities and developments at http://www.ncmedsoc.org/payor_issues/workers_compensation.html and in the Bulletin.

You must have a subscription to view the full article at WorkCompCentral.com®:

http://ww3.workcompcentral.com/news/story/id/30935f9278a6c2373a5c4ed8c264035fm

See related story:

NC Industrial Commission Delivers on E-Billing and Electronic Payment in Workers Comp, Bulletin, 6-17-11

More US doctors facing charges over drug abuse, 9-14-11, Reuters

Writer Terry Baynes reports that prosecutors are stepping up efforts to confront the growing abuse of prescription drugs.

How changes in workers’ comp will affect N.C. manufacturers, 9-9-11, Charlotte Business Journal

Contributing writer Julie Bird examines changes in North Carolina’s workers’ compensation law.

Census report: More Americans relying on Medicare, Medicaid, 9-13-11, The Christian Science Monitor

Writer Daniel B. Wood reports on a growing reliance on state and federal health insurance programs.

U.S. claims bigger share of health coverage market, 9-13-11, The Washington Times

Writer Paige Winfield Cunningham reports that fewer people received health insurance coverage through their employer in 2010 than in 2009.

Debate exchange offers window into larger question about role of health care, 9-12-11, CBS News/Political Hot Sheet

Robert Hendin, producer of Face the Nation and a CBS News senior political producer, writes about the CNN Republican debate and how candidates answered a question about who should pay for medical care of the uninsured.

Watson Goes to Work on Health Care, 9-12-11, Portfolio.com (Business Journals)

In his blog column “Heavy Doses,” writer Kent Bernhard, Jr. provides an overview of Wellpoint’s plan to utilize the Watson supercomputer to analyze health care data.

UN investigator says medical waste risks ignored, 9-14-11, The News and Observer/Associated Press

AP writer John Heilprin looks at an UN investigator’s report that finds up to a quarter of the world’s trash is from hospitals, clinics, labs, blood banks and mortuaries, and that more needs to be done to regulate it.

Experts: 366 million people now have diabetes, 9-13-11, The News and Observer/Associated Press

AP writer Maria Cheng looks at the worsening global epidemic of diabetes.

Study uncovers mistaken beliefs about new drugs, 9-13-11, The News and Observer/Associated Press

AP writer Carla K. Johnson reports on a new study that finds many consumers mistakenly believe new prescription drugs are safer.

The Industrial Commission (IC) has announced that it will require carriers and providers to develop and use electronic billing and payment processes in the administration of workers’ compensation claims. The IC announced its unanimous and long-awaited decision in Minutes released on June 14, 2011.  The Minutes cite access to care for workers’ comp patients, reduced administrative burdens, consistency with national standards for electronic health care transactions, and increased overall efficiency in workers’ comp as the reasons behind the new policy. The IC will be developing agency rules to implement the requirement.

For years, the NCMS has worked tirelessly to simplify workers’ comp claims submission and payment processes for physician practices. Tuesday’s announcement marks a big step toward that ultimate goal. 

NCMS also anticipates that the rules will also resolve the “ICD-10 dilemma” facing the workers’ compensation system: federal regulations that require medical practices to adopt 5010 and ICD-10 do not apply to entities that operate in state workers’ compensation systems (such as the Industrial Commission and work comp insurance carriers). So as most of the health care industry made the transition, medical practices treating workers’ comp patients would be forced to operate in both the 4010/ICD-9 realm and the 5010/ICD-10 realm. But this week’s developments will hopefully eliminate that scenario. 

As part of the process, the IC will also be upgrading its systems to include an electronic data interchange (EDI) interface, allowing it to receive medical billing information when appropriate.

The NCMS and its IC Task Force wishes to thank Commissioner Staci Meyer for her commitment and dedication to this effort. Commissioner Meyer worked closely on the project with the NCMS, medical group managers, and workers’ comp carriers, and successfully gained the support of the other five members of the Industrial Commission.

Senate Discusses Proposed Budget Cuts    

The Senate previewed its proposed budget this week.  The Senate proposed a Medicaid provider cut of 3%, higher than the 2% proposed by the House.  Physicians, whose rates have been cut in previous years, would be shielded from any rate cuts initially, but may be subject to a 2% cut should Community Care of NC (CCNC) fall short of its savings goal. The Senate reduced the savings goal for CCNC to $83 million and took an additional $10 million from the Health and Wellness Trust Fund to reduce the burden on CCNC. 

New Medicaid cuts included a variety of optional service reductions or eliminations that could threaten the integrity of the Medicaid program.  The proposed cuts would severely limit services to be provided for rehabilitation and other therapy that expedite hospital discharge and prevent recurring visits to the Emergency Department.  The NCMS and other groups interested in the Medicaid program, expressed reservations about these cuts to budget leaders this week. 

Late on Thursday, budget writers from both chambers were working to reach compromises in every area of the budget.  Talks are expected to continue on Friday in advance of the Memorial Day holiday. The talk around the legislature indicates that the Senate and House are pre-conferencing the budget. This is something that has not been the practice in the past but could save weeks of more formal conference committee negotiations if successful.  The NCMS will continue to report progress to you during this fast-paced, dynamic period.

Workers’ Compensation Reform

The House Select Committee on Tort Reform heard HB 709 – Protect and Put NC Back to Work today. The committee debated a proposed committee substitute that was the consensus product of the business community, trial lawyers and the medical community. Read the details of the newly proposed bill here. The NCMS is working to establish a clear process for employer communication with the treating physician, protection from lawsuits for the physician, and compensation for any administrative costs incurred as a result of the new legislation.

A late addition to the bill is of significant importance to the physician community.  The new Section 8 provides that the Industrial Commission meet ICD-10 deadlines, and adopt rules to enable electronic billing and payment. This protection will ensure that physicians seeing injured workers will only have to deal with one set of billing codes.

The NCMS would like to express its appreciation to all of the bill sponsors, but most especially to Rep. Dale R. Folwell (R-Forsyth) for his leadership during the complicated negotiation that brought about this bill.  Rep. Folwell took the time to fully understand the impact for each provision, listen to all sides of the debate and held firm to his commitment to reach a compromise bill.

Health Benefit Exchange passes the House

Legislation that would authorize the creation of a NC Health Benefit Exchange passed the House on Wednesday with bipartisan support.  H115 – Health Benefit Exchange would form a Board and empower that board with the ability to create the “Expedia of health insurance” for NC. NCMS has worked closely with proponents of the bill.  Meaningful progress is required to receive additional federal funds by January, 2012 and the exchange is supposed to be enrolling by January, 2013. With such a short window to develop the massive IT infrastructure for this project, NCMS has supported the passage of this bill during the current session.  Opponents of the bill have railed against the governing structure of the board that includes experts from a number of different fields. Other opponents have cited flaws in the federal Affordable Care Act. The NCMS continues to believe that so long as the federal law is in place, the State should take action to create and control the Exchange rather than allow the federal government to do so. A provision included in the bill dissolves the exchange in the event the federal law is found to be unconstitutional.

Legislative Committee on New Licensing Boards Take Action on Naturopaths

Tuesday afternoon, the Legislative Committee on New Licensing Boards issued their assessment report on the Licensure of Naturopaths in North Carolina. The release of this report is the first step in the legislative process for both SB 467 and HB 847. Both bills will now be referred to the Health Committees in their respective chambers. The NCMS maintains its position that the proposed board to license naturopaths lacks the structure and economic resources to legitimately regulate naturopathic practitioners.  Additionally, the proposed legislation creeps into other areas of currently licensed healing arts such as the practice of physical therapy, chiropractics and would license colon hydro-therapy.

The Committee also heard public comment this week on legislation proposed to create the Medical Imaging and Radiation Therapy Board of Examiners, it is expected the committee will vote on this draft report in the next week.

Other bills that this committee may consider in the future include the licensure of lay midwives, music therapists, radiologic assistants and clinical exercise physiologists.

Other Legislation Acted On This Week:

HB 656 – Controlled Substance Photo ID

Three separate but related bills were combined into one proposed committee substitute by a subcommittee of the House Judiciary B Committee. The final bill required photo ID when dispensing a controlled substance at a pharmacy. It left out proposed language that would have allowed Sheriffs access to the Controlled Substance Reporting System (CSRS) as well as a burdensome requirement for health care providers to review or insert 12 months of background data into the CSRS before prescribing Schedule II and some Schedule III drugs. The NCMS worked closely with other medical partners to ensure this outcome. The bill received a favorable report in committee and now awaits placement on the House calendar for a floor vote.

•  HB 298 – Insurance Amendments – AB, Dockham (R-Davidson)
• SB 245 – Medicaid Billing by Local Health Departments, Hartsell (R-Cabarrus)
  • Chaptered Session Law 2011-90
• SB 316 – Additional Section 1915 Medicaid Waiver Sites, Hartsell (R-Cabarrus)
• SB 323 – State Health Plan/Appropriations and Transfer II, Apodaca (R-Henderson)
  • Became law without signature. Chaptered Session Law 2011-85
• SB 608 – Health Care Sharing Organizations, Hunt (R-Wake)

Events/meetings involving NCMS staff working on your behalf this week.

With the expansion of Medicaid and the individual mandate to obtain health insurance brought about by Health System Reform comes the need for expanded access to quality health care providers.   In an attempt to address the inevitable shortage of medical providers the Patient Protection and Affordable Care Act has called for the creation of a National Health Care Workforce Commission.   The legislation requires that this group be appointed and operational no later than September 30^th of this year and to prepare, the U.S. Government Accountability Office has been seeking recommendations for members throughout the summer. 

The Commission will be tasked with determining if the demand for health care workers is being met, identifying possible barriers to health care workforce development and making recommendations to Congress based on their findings.

Fifteen members will serve on the Commission, each appointed to three year terms by the Comptroller General. Health care professionals cannot constitute more than half of the workforce, leaving other seats open to representatives of employers, third party payers, health care economists, consumers, labor unions, educational institutions, and state or local workforce investment boards.

Legislators have penned specific priorities for the Commission to focus on throughout the course of their evaluations which include integrated workforce planning for nursing, oral, mental, public, allied, and emergency health providers.  Also of significance is the Commission’s ability to evaluate existing scopes of practice in the health care sector and make recommendations to Congress.

The creation of the National Health Care Workforce Commission is accompanied by a number of development grants for eligible State Workforce Development Boards to analyze local health care workforce needs and provide resources to help meet those needs. Individual providers may also apply for a number of workforce development grants or loan repayment programs.   Many of these opportunities are focused on growing the nursing field, however programs also exist to repay loans for pediatric and public health physicians as well.