MGMA sends suggestions to CMS over HIPAA rule
The Medical Group Management Association (MGMA) has sent a letter to the Centers for Medicare & Medicaid Services (CMS) outlining their recommendations on the interim final rule (IFR), ”HIPAA Administrative Simplification: Adoption of Operating Rules for Eligibility for a Health Plan and Healthcare Claim Status Transactions.”
Dated Sept. 6, William F. Jessee, MD, president and CEO of MGMA remarked that the Englewood, Colo.-based organization supports the development and implementation of operating rules to improve administrative transactions used in physician practices.
According to Jessee, CMS should name the Council for Affordable Quality Healthcare (CAQH) Committee on Operating Rules for Information Exchange (CORE) as the lead authoring entity for the development of all the operating rules mandated under the IFR. “CAQH CORE has created a critical infrastructure and fostered a multi-stakeholder, consensus-building rules development process necessary to create effective operating rules in a timely manner,” he wrote.
Additionally, MGMA suggested that the operating rules work closely with the standards developing organizations to ensure continuity between the operating rules and the underlying standards. “As the operating rules are developed and adopted by the authoring entity, there should be opportunity for the public to offer input and request clarification and interpretation,” the organization added.
According to MGMA, CMS should include the acknowledgement transactions as part of the operating rules for eligibility and claim status.
“Outreach to all impacted stakeholders will be critical to the success of operating rules,” Jessee wrote. “In particular, we encourage CMS to aggressively communicate to physician practices and vendors of practice management system software throughout the operating rules development and adoption phases.
“We believe that the development of appropriate operating rules for the administrative transactions identified in Patient Protection and Affordable Care Act (PPACA) will lead to significant simplification of the healthcare system and result in reduced costs for physician practices and other stakeholders,” the letter concluded. “We support the designation of CAQH CORE as the designated entity to develop the eligibility and claim status operating rules and urge the agency to name this organization as the authoring entity for the remaining operating rules mandated by the PPACA.”
Dated Sept. 6, William F. Jessee, MD, president and CEO of MGMA remarked that the Englewood, Colo.-based organization supports the development and implementation of operating rules to improve administrative transactions used in physician practices.
According to Jessee, CMS should name the Council for Affordable Quality Healthcare (CAQH) Committee on Operating Rules for Information Exchange (CORE) as the lead authoring entity for the development of all the operating rules mandated under the IFR. “CAQH CORE has created a critical infrastructure and fostered a multi-stakeholder, consensus-building rules development process necessary to create effective operating rules in a timely manner,” he wrote.
Additionally, MGMA suggested that the operating rules work closely with the standards developing organizations to ensure continuity between the operating rules and the underlying standards. “As the operating rules are developed and adopted by the authoring entity, there should be opportunity for the public to offer input and request clarification and interpretation,” the organization added.
According to MGMA, CMS should include the acknowledgement transactions as part of the operating rules for eligibility and claim status.
“Outreach to all impacted stakeholders will be critical to the success of operating rules,” Jessee wrote. “In particular, we encourage CMS to aggressively communicate to physician practices and vendors of practice management system software throughout the operating rules development and adoption phases.
“We believe that the development of appropriate operating rules for the administrative transactions identified in Patient Protection and Affordable Care Act (PPACA) will lead to significant simplification of the healthcare system and result in reduced costs for physician practices and other stakeholders,” the letter concluded. “We support the designation of CAQH CORE as the designated entity to develop the eligibility and claim status operating rules and urge the agency to name this organization as the authoring entity for the remaining operating rules mandated by the PPACA.”