HHS to standardize medical e-transactions
- By Colleen O'Hara
- Aug 21, 2000
The Department of Health and Human Services issued a regulation last week
that will standardize — and encourage — electronic health care transactions,
saving billions of dollars in the long term.
The regulation, released Aug. 17 in the Federal Register, affects federal
and private health care programs such as Medicare and Medicaid by requiring
the use of standard formats and standard procedure codes whenever medical
claims are processed electronically.
Health insurers currently require health providers to use many different
paper and electronic forms to file claims.
Providers will still be able to use paper forms, but HHS expects that
the new electronic standards will encourage more electronic filing, saving
the health care industry $29.9 billion in 10 years, according to the department.
However, there may be some "short-term pain" and initial "significant
cost" for companies that transmit and process electronic claims that do
not comply with the new national standard, said Mark Leavitt, chairman
of Medica-Logic/Medscape Inc., which provides systems to manage clinical
MedicaLogic/Medscape is not directly affected because the regulation
applies to administrative claims, not clinical records, Leavitt said. But
he said he does expect some concrete benefits. "I think it's a precursor
to more" standardization and more requirements to "submit things in digital
format whether they're claims or clinical records," he said. The move should
also "facilitate the development of software or applications that work more
broadly," he said. "That always makes them less expensive." The regulation
was mandated under the Health Insurance Portability and Accountability Act
of 1996 (HIPAA).
The regulation also includes these provisions:
n Health plans will be able to pay providers, authorize services, certify
referrals and coordinate benefits using a standard electronic format for
n Providers will be able to use a standard format to determine eligibility
for insurance coverage, inquire about claim status, request authorizations
for services and receive electronic remittance to post receivables.
n Employers that provide health insurance to their workers will be able
to use a standard electronic format to enroll or unenroll employees and
to submit premium payments to any health plan for which they have a contract.
An HHS spokesman made no one available to comment on the regulation.
But HHS Secretary Donna Shalala said in a statement that the rule is being
released under the assumption that privacy protections will be in place
at about the same time the rule takes effect in October 2002.
HHS said it expects to release a final rule pertaining to the privacy
of medical records later this year.
Last month, before an HHS advisory committee, Donald Bechtel, strategic
adviser for Healthcare Data Exchange Corp. and Shared Medical Systems Corp.,
both subsidiaries of Siemens Corp., said the companies have implemented
several transactions required by HIPAA.
"The bottom line is: These transactions work, they're efficient, they
reduce the cost of these business transactions, they reduce errors in data
and free people to do other important work," he testified. "Providers will
be positively affected in terms of return on investment because of the standard
transaction formats and the efficiencies they make possible."Related links