Here is some new information that I received today on HCFA administrative
procedures -- Any comments???
HHS Proposes Administrative Simplification
Standards For Health Care Transactions
Thu, 07 May 1998 18:53:01 GMT
HHS Proposes Administrative Simplification Standards For Health Care
Transactions WASHINGTON, May 7 (Dept. of Health and Human Services) - HHS
Secretary Donna E. Shalala today announced new proposals to streamline
the processing of health care claims and reduce the amount of paperwork
required in the U.S. health care system.
The plans include a requirement that every health care provider --
hospitals, doctors, nursing homes, and others -- be provided with a
unique alpha-numeric identifier to be used in filing claims for
reimbursement by public and private insurance programs. HHS also is
proposing regulations that would establish a standard format for the
submission of electronic claims.
"These are important steps toward a faster, simpler, less costly,
and more efficient health care system," Secretary Shalala said.
"We are working with the private sector to prepare our nation for
the information age in health care."
At present, health care providers are assigned different identification
numbers by private health plans, hospitals, nursing homes, and such
public programs as Medicare and Medicaid. These multiple provider ID
numbers result in slower payment of bills, increased costs, and a lack of
coordination.
The proposed rules published in today's Federal Register are two of the
administrative simplification steps provided for in the Health Insurance
Portability and Accountability Act of 1996 (HIPAA). By promoting the
greater use of electronic transactions and the elimination of inefficient
paper forms, the regulations are expected to save at least $1.5 billion
over the first five years of implementation.
Under the first proposed rule, health care providers would apply for an
eight-digit identifier that they would use whenever processing claims
electronically. They would apply for that identifier only once and keep
it when they move from one state to another or if they change
specialties.
Under the second rule published today, every health care provider would
be able to use a single standard electronic format to bill for services
rendered. All health plans would be required to accept these standard
electronic claims. Currently, different insurers utilize different
electronic and paper claims forms creating a confusing and cumbersome
system for health care providers and taking providers' time away from
their patients.
The electronic claim proposal also includes new standards for other
common transactions and for reporting diagnoses and procedures in the
transactions. Health plans will be able to pay providers, authorize
services, certify referrals, and coordinate benefits using one standard
electronic format for each transaction. Using a standard electronic
format, providers will be able to inquire about whether a patient has
insurance coverage or the status of a claim or request authorizations for
services or specialist referrals.
Employers who provide health insurance to their workers and their
dependents also will be able to use a standard electronic format to
enroll or disenroll employees and to make premium payments to any health
plan with which they contract to do business.
"These efforts will help more providers move from paper to
electronic transactions," said Nancy-Ann DeParle, administrator of
the Health Care Financing Administration, which runs the Medicare and
Medicaid programs. "This will make information exchange more
efficient and accurate, and result in better service for consumers."
Later this year, HHS will issue other administrative simplification
proposals to establish national ID numbers for health plans and employers
and to establish stringent new security rules to protect patient
confidentiality.
Peter R. Kovacek, MSA, PT
KovacekManagementServices, Inc.
The FOCUS Group, Inc.
20225 Danbury Lane
Harper Woods, MI 48225
(313) 884-8920
(313) 884-8510 Fax
<http://www.theFOCUSgroup.net>
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