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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
Transactions, Code Sets and Identifiers (NPI) Update Jim Whicker, CPAM Intermountain Healthcare Director of EDI, A/R Management Chair, WEDI AAHAM EDI Liaison.
Todd Frech Ocius Medical Informatics 6650 Rivers Ave, Suite 137 North Charleston, SC Health Insurance Portability.
1 THE COMMONWEALTH FUND Uninsured Top Priority for Congress According to Health Care Opinion Leaders Source: The Commonwealth Fund Health Care Opinion.
1 THE HIPAA COLLOQUIUM at Harvard University HIPAA Compliance Strategies for Clearinghouses Thursday, August 22, 2002 James Mechan Senior Vice President.
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1 JCAHO –A HIPAA Business Associate National HIPAA Summit Anthony J. Tirone, JD,MBA Director, Federal Relations Joint Commission on Accreditation of Healthcare.
Privacy and Security: Creating a Culture of Compliance from Purchase to Production Catherine Gorman Klug RN, MSN Corporate Director Privacy and Data Security.
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