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Payer – Provider Interoperability Issues Created by the HIPAA Administrative Simplification Provisions MEDINF 405-DL Dave Robbins
Provider-Payer Administrative Provision Transactions Payment and Remittance Claims and Encounters Claim Status and Inquiry Code Sets HCPCS CPT-4 ICD-9 Identifiers Providers Employers Patients
Goals Not Reached Redundancy Limited evidence of ROI Limited Efficiency Compliance Costs
Problem 1: Lack of Business Rules Standards Defined Without Business Rules Payers Published Standalone Companion Guides with Unique Interpretations Little or No Net Reduction in Complexity
Problem 2: Complex Systems Environment Mergers and Acquisitions Legacy Systems Commingled With Modern Systems Peripheral Systems
Problem 3: Missing Pieces Provider Identifier 12 Years for Implementation Employer Identifier Patient Identifier Failed
Possible Solutions Regional Cooperatives NEHEN Health Plan Cooperatives Availity United Health
Conclusion Preferred Solution: Federally Responsibility Medicare Claims Management Policy HIPAA Transaction Clarification Solve Unique Patient Identifier Problem
Provider Perspective on Medicare’s COB Edits By George Arges.
© 2009 The McGraw-Hill Companies, Inc. All rights reserved. 1 McGraw-Hill Chapter 4 The HIPAA Transactions, Code Sets, and National Standards HIPAA for.
HIPAA Administrative Simplification Final Rule for Transactions Code Sets Stanley Nachimson
X12N Task Group 3/Work Group 2 July2000 Health Care Transactions ANSI ASC X12N Insurance Sub-Committee Task Group 3 Business Transaction Coordination and.
Thomas D. Bixby Law Office LLC (608) May 12-14, 2010 New Orleans, LA Health Reform and Administrative Simplification: Keeping.
Lesson 1 Overview of the 837 and Section 1: Overview Introduction How did we get to where we are now? What do electronic transactions mean to you.
HIPAA Medicare FFS Issues Fourth National HIPAA Summit April 26, 2002 Janis Nero-Phillips Director OIS/Division of Data Interchange Standards.
1 February 8 th, 2006 February 8 th, Benefits of EF Benefits of EF Faster payment on electronic claims. Electronic transactions.
HIPAA Vendor Conference Greg Moody Executive Assistant for Health and Human Services Office of Ohio Governor Bob Taft.
Health Information Technologies and Health Care Transformation James Golden, PhD Director, Division of Health Policy Minnesota Department of Health February.
Presented by Elena Chan, UCSF Pharm.D. Candidate Tiffany Jew, USC Pharm.D. Candidate March 14, 2007 P HARMACEUTICAL C ONSULTANTS, I NC. P RO P HARMA HIPAA.
1 Health Insurance Portability and Accountability Act of 1996 IS&C Expo October 16 & 17, 2002 John Wagner Governor’s Office of Technology.
Blair Elledge Quadax, Inc Discussion Topics Intended Purpose, Benefits, Why Change? 5010 Transactions…much more than claims Everyday Impact of.
Medicaid Management Information System (MMIS) Replacement Design, Development and Implementation Phase.
Facilitators: Kit Cairns, Dean Health Greg Margrett, Netwerkes/Ingenix.
HIPAA COMPLIANCE FANTASTIC FOUR CASEY FORD MANINDER SINGH RANGER OLSOM Information Security in Real Business.
HIPAA Yesterday, Today and Tomorrow? Dianne S. Faup Office of HIPAA Standards Centers for Medicare & Medicaid Services.
S I D L E Y & A U S T I N HIPAA and Your Compliance Program HCCA’s 2000 Compliance Institute New Orleans, Louisiana September 25, 2000.
Dr. Yaseen Hayajneh Health Insurance Portability and Accountability Act Yaseen HayajnehYaseen Hayajneh RN, MPH, PhD.
N ational P rovider I dentifier Western Highlands Network.
Implementing and Enforcing the HIPAA Transactions and Code Sets 6 th Annual National Congress on Health Care Compliance February 6, 2003.
Hector Rodriguez, Microsoft Eric Mueller, Washington Publishing Company March 2009 Get More Out of HIPAA 5010 & ICD 10 Compliance with Microsoft’s Integrated.
STEVEN S. LAZARUS, PHD, CPEHR, CPHIT, FHIMSS PRESIDENT, BOUNDARY INFORMATION GROUP AUGUST 20, – The Twelve Year Journey is Not Over.
Information Technology for the Health Professions, Third Edition Lillian Burke and Barbara Weill Copyright ©2009 by Pearson Education, Inc. Upper Saddle.
What's Happening in the States? HIPAA Compliance in the Medicaid Setting: What's Happening in the States? Andrea S. Danes, Illinois Medicaid Chair, National.
Is Your Practice Ready for HIPAA Transactions, Code Sets and Testing? Mark Charles Consultant, Altarum David McLaury Director of Project Development and.
HIPAA Summit 10 Apr 7, Transaction-Based Business Intelligence Leveraging HIPAA to Gain Value from Transaction Data Joseph C Nichols MD Director.
BEHAVIORAL HEALTH CODING CHANGES 2013 EFFECTIVE JANUARY 1 ST, 2013.
Health Care Reform Cost Savings Julie Sonier Director, Health Economics Program Minnesota Department of Health SCI Summer Meeting July 31, 2008.
©2010 RealMed Corporation. RealMed Overview National Committee on Vital and Health Statistics Subcommittee on Standards Sean Kilpatrick, Director of Product.
PowerPoint to accompany Law & Ethics For Medical Careers Fourth Edition Judson · Harrison · Hicks Chapter 7—Privacy Law and HIPAA Copyright © The McGraw-Hill.
Slide 0 Copyright © 2008, 2006, 2004 by Saunders an imprint of Elsevier Inc. All rights reserved.
Copyright © 2003 HealthTrio, Inc. 1 Achieving HIPAA and E-Business Objectives in Less than 90 days Ralph A. Korpman, MD CEO, HealthTrio 6 th Annual HIPAA.
Being the new reimbursement manager, I hope to work with you all for the benefit of this entity. I manage reimbursement transactions, as well as facilitating.
HIPAA History March 3, HIPAA Ruling Health Insurance Portability Accountability Act Health Insurance Portability Accountability Act Passed by Congress.
Copyright ©2014 by Saunders, an imprint of Elsevier Inc. All rights reserved 1 Chapter 08 The Electronic Claim Insurance Handbook for the Medical Office.
Chapter 1 Chapter 1 Role of an Insurance Billing Specialist Elsevier items and derived items © 2010, 2008 by Saunders, an imprint of Elsevier Inc.
Clyde Hanks, COO The Health Care Interchange of Michigan The Eight National HIPAA Summit March 7 – 9, 2004 Baltimore, MD.
Electronic Submission of Medical Documentation (esMD) Face to Face Informational Session esMD Requirements, Priorities and Potential Workgroups – 2:00pm.
Chapter 8 Electronic Data Interchange: Transactions and Security Electronic Data Interchange: Transactions and Security Elsevier items and derived items.
2010 Changes – Physician Fee Schedule Billing & Reimbursement for Consultations December 16, 2009.
HIPAA Michigan Cancer Registrars Association 2005 Annual Educational Conference Sandy Routhier.
© 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 5 The Health Insurance Portability and Accountability Act (HIPAA) Jahangir Moini, MD, MPH,
HP Provider Relations October 2011 Medical Review Team.
1 Massachusetts All-Payer Claims Database: Technical Assistance Group (TAG) July 9, 2013.
Larry Watkins Vice President & COO, Claredi Corporation Co-Chair, ASC X12N Health Care Task Group Co-Chair, WEDI Strategic National Impl. Process (SNIP)
USING THE AVAILITY WEB PORTAL TO BUILD A HEALTHIER BUSINESS DENISE PULCIFUR.
Comprehensive Health Insurance Billing, Coding, and Reimbursement Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights.
RVU Relative Value Unit Report Copyright © 2012 Waiting Room Solutions.
Implementing HIPAA Centers for Medicare & Medicaid Services Fourth National HIPAA Summit April 25, 2002 Jared A. Adair Director Office of Operations Management.
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