AHIMA: HIPAA transaction standards are here to stay
Transaction standards were first written into HIPAA legislation in 2000 to create standardized routes for healthcare organizations to exchange financial and administrative data, but they left too much room for interpretation and the result has been chaotic, according to a Jan. 17 article in the Journal of the American Health Information Management Association (AHIMA).
“Providers, vendors, clearinghouses and health plans have developed their own rules for following the standards when exchanging information,” Journal of AHIMA Staff Writer Chris Dimick wrote. “The outcome has been disorganization and discrepancies between trading partners.”
The standards were intended to make information exchange more simple and efficient, but differences in state laws, individual organizations’ processes and policies, proprietary software and lax federal enforcement have encouraged separate organizations to develop separate ways of using the standards.
To improve the currently unruly state of transaction standards, the Patient Protection and Affordable Care Act (PPACA) included an operating rule mandate to help streamline data exchange and the Department of Health and Human Services (HHS) has since published two operating rules regarding transaction standards for “eligibility for a health plan” transactions and “health claim status inquiry” transactions.
The two operating rules published by the HHS, which healthcare organizations have until January 2013 to implement, contain processes for improving the way patient names are stored and contain a requirement that requests for data be responded to in a set amount of time. Dimick said that this will reduce misidentifications and mistaken denials.
Some organizations have voluntarily complied with the recently published rules and benefited from compliance, according to Dimick. He pointed to BlueCross BlueShield of Tennessee (BCBST), which has gained operational efficiencies and administrative cost savings from implementing the operating rules.
“Real-time electronic transactions have greatly increased, allowing the health plan to instantly provide information to providers on patient eligibility for care either before the patient arrives or while he or she is receiving care,” Dimick wrote. “This has reduced phone calls, because providers get the results instantly, which has led to a reduction in operating costs for both BCBST and the providers it works with.”
Although compliance with the transaction standards has technically been required for years, the PPACA mandate will bring enforcement to fruition, according to Dimick. The PPACA requires the HHS to create a process for verifying compliance and to levy financial penalties for noncompliance, he said.
Although implementation has been difficult to achieve over the past decade, Dimick suggested the recent upgrade to version 5010, increased familiarity with HIPAA transactions and a long enough time table should make implementation manageable.
Read the article in its entirety here.
“Providers, vendors, clearinghouses and health plans have developed their own rules for following the standards when exchanging information,” Journal of AHIMA Staff Writer Chris Dimick wrote. “The outcome has been disorganization and discrepancies between trading partners.”
The standards were intended to make information exchange more simple and efficient, but differences in state laws, individual organizations’ processes and policies, proprietary software and lax federal enforcement have encouraged separate organizations to develop separate ways of using the standards.
To improve the currently unruly state of transaction standards, the Patient Protection and Affordable Care Act (PPACA) included an operating rule mandate to help streamline data exchange and the Department of Health and Human Services (HHS) has since published two operating rules regarding transaction standards for “eligibility for a health plan” transactions and “health claim status inquiry” transactions.
The two operating rules published by the HHS, which healthcare organizations have until January 2013 to implement, contain processes for improving the way patient names are stored and contain a requirement that requests for data be responded to in a set amount of time. Dimick said that this will reduce misidentifications and mistaken denials.
Some organizations have voluntarily complied with the recently published rules and benefited from compliance, according to Dimick. He pointed to BlueCross BlueShield of Tennessee (BCBST), which has gained operational efficiencies and administrative cost savings from implementing the operating rules.
“Real-time electronic transactions have greatly increased, allowing the health plan to instantly provide information to providers on patient eligibility for care either before the patient arrives or while he or she is receiving care,” Dimick wrote. “This has reduced phone calls, because providers get the results instantly, which has led to a reduction in operating costs for both BCBST and the providers it works with.”
Although compliance with the transaction standards has technically been required for years, the PPACA mandate will bring enforcement to fruition, according to Dimick. The PPACA requires the HHS to create a process for verifying compliance and to levy financial penalties for noncompliance, he said.
Although implementation has been difficult to achieve over the past decade, Dimick suggested the recent upgrade to version 5010, increased familiarity with HIPAA transactions and a long enough time table should make implementation manageable.
Read the article in its entirety here.