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A coalition of health-care vendors and providers is urging the government to make sure that health-care payments are not disrupted or delayed as the industry moves to comply with new national standards for electronic health-care records, which are required by the Health Insurance Portability and Accountability Act.
The Centers for Medicare & Medicaid Services (CMS), the largest health-care payer in the country, has stated that after July 2004 it will delay claims that dont meet HIPAA formatting standards. But many of the intermediaries between health-care providers and CMS—the ultimate payer—will not be able to process the claims, according to the coalition, called the HIPAA Implementation Working Group.
Jack Emery, assistant director of federal affairs at the American Medical Association, called on the government to do more to ease the transition to HIPAA compliance, stating that current efforts have decreased rather than increased the efficiency of processing health claims.
“The current haphazard migration process has increased transaction costs and continues to present a risk of disrupting health-care payments and therefore health-care services,” Emery said.
The coalition includes groups representing physicians, hospitals, clinical laboratories, vendors and clearinghouses. Its members are professionals associated with the American Medical Association, theAmerican Hospital Association, the Laboratory Corporation of America Holdings, WebMD Corp. and the Association for Electronic Health Care Transactions (AFEHCT).
The coalition recommended that CMS not delay Medicare or Medicaid payment to providers even if they do not submit claims in the HIPAA standard format, provided that they are actively testing or requesting to test their compliance with the regulations.
Claims that are lacking some data also should not be delayed, the group said, as long as data is included to determine the claims validity. The coalition also said compliance should be implemented in steps, with the HIPAA claim form as CMS first priority. Then, other transactions should be phased in to create the least disruption to the system. Finally, CMS should set forth a process to resolve differing opinions on HIPAA standards, the group said.
The statement, which was released March 31, can be found here in PDF form.