HIPAA Regulatory Alert

MGMA concerned about e-claims standards

Group urges incentives for providers

The Medical Group Management Association (MGMA) has raised concerns about electronic claims attachments with federal officials.

In a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Mark McClellan, MGMA said its members support administrative simplification and believe that, once properly implemented, e-claims attachments can streamline an important billing transaction for medical group practices. It raised 11 general issues for consideration:

1. Standards should be flexible and scalable. MGMA said any standards for electronic claims attachments should take the wide variety of clinical specialties and settings into account.

"The final standard must be both flexible and scalable to encourage adoption by both small and large health care organizations and physician specialties processing both low and high volumes of claims attachments," it said. "Flexibility will allow doctors to consider critical factors such as clinical quality, safety, efficiency, and integration with existing practice management software and electronic health record systems when making an investment."

2. No undue burdens on providers. MGMA said it is critical that CMS develops a final rule that doesn't impose undue financial burdens on physician practices.

3. Promote the security and privacy of patient data. MGMA said electronic claims attachments must maintain HIPAA security and privacy standards as part of their core features and CMS should provide guidance on the critical issues surrounding the minimum necessary provision of the privacy regulation.

4. Incentives for providers. The association calls for realigning incentives by promoting appropriate public and commercial reimbursement programs. MGMA said it has supported the concept of a federal program of tax credits for physician investments in health technology that could serve as a significant incentive. Also, a federally guaranteed loan fund for physician health technology investments, coupled with loan forgiveness for service to medically underserved populations, could be an effective stimulus to e-health adoption.

5. Technology savings accounts. MGMA wants the federal government to explore methods to assist medical practices in acquiring health information technology. It suggests technology savings accounts would provide a reduced level of taxation for funds designated for practice health information technology and says such accounts could enable group practices to pay for current expenses and save for future qualified health information technology expenses tax-free. Unspent account balances could accumulate interest.

6. Stark regulation safe harbor. According to MGMA, anti-kickback and self-referral concerns prevent some health care organizations from offering free or discounted technology to medical practices.

The association wants government approval of legal protections, such as safe harbors and regulatory exceptions, to facilitate health technology implementation.

7. Development of clinical and administrative crosswalks. CMS should develop and freely make available crosswalks between ICD, CPT, and LONIC code sets, MGMA says.

8. Staggered compliance dates. MGMA calls on the federal government to stagger implementation dates to give clearinghouses and health plans time to upgrade and test systems before provider information takes effect. It says piloting of the e-claims attachments standard should be completed before full national implementation to identify and correct problems.

9. Development of a national rollout plan. CMS should initiate a national rollout plan taking into account requirements of each impacted industry sector, MGMA recommends.

10. Continued consultation with the physician practice community. MGMA encourages CMS to continue its outreach to physicians to ensure their requirements and concerns are addressed.

11. Industry outreach. MGMA says physician practices will need substantial education before they are fully aware of and comfortable with e-claims attachments. And CMS also should be communicating with the software vendor community to encourage them to move forward with product development as quickly as possible.

More information is available at www.mgma.org.