HIPAA Regulatory Alert

AHA wants contingency period for attachment rule

AHA warns standard should have strict limits

The American Hospital Association (AHA) has told the Centers for Medicare & Medicaid Services (CMS) that hospitals should have a contingency period of at least three years after a final rule on standards for electronic health care claims attachments is issued to allow hospitals adequate time to prepare budgets, train staff, and conduct testing with their trading partners.

In comments on a proposed rule for the standards, the AHA said it welcomed many of the proposal's recommendations, but emphasized the importance of having an attachment standard that also imposes specific limitations on its use. "Without strict limits," the AHA said, "we will see inappropriate use of the attachment standard. The practice of requesting an attachment should be rare and never become a routine item that would accompany all claims for a specific type of service. Health plans and others that require routine reporting of a particular piece of data have opportunities to present their requests to the appropriate data content committees. Misuse of the attachment standard will increase not only the administrative burden and costs for providers, but more importantly, the potential for privacy violations."

The AHA cautioned the proposed standards introduce several elements not widely used in the current billing process, thus requiring new methods for capturing and handling clinical information at significant cost to providers. "We believe the attachment standards will yield a zero net return on investment for hospitals," the association said. "Moreover, the attachment standards will be far costlier to implement than the previous HIPAA claims standards."

One area of significant concern to providers not directly mentioned in the proposed rule involves establishment of a formal communication process between providers and health plans, the AHA said. "Today, many claims are delayed pending additional information from the provider," the AHA said. "However, hospitals are often unaware that the health plan has submitted a request for additional information and are left wondering about the status of their claims. The health plan's request is often lost as it moves from the health plan to the clearinghouse and sometimes even to an unspecified location within the provider's operation. The communication flow is unpredictable. Clearinghouses usually do not know how to handle such requests, and consequently they are unable to direct the request to the responsible person at the provider's operation.

"We would welcome a set of comprehensive business rules that would improve how covered entities would formally communicate with one another to handle such requests on a timely basis. While the request transaction standard includes specific contact information about the contact at the health plan, there is no comparable segment for the provider to indicate the contact person within its operations. It is unfortunate that the claim standard does not have a similar segment that would allow providers to designate contact persons within their organizations to handle specific types of attachment requests. We recommend CMS establish a technical group to explore options for creating better communications between providers and plans."

Finally, AHA recommended that CMS issue rules for ICD-10 adoption before finalizing the rule for claim attachments, since ICD-10 provides greater clinical specificity and has the ability to reduce or eliminate reliance on claim attachments.