Electronic standards pose operational hurdles
Electronic standards pose operational hurdles
Health care providers have two years to comply with the electronic standards for health care transactions released by the Department of Health and Human Services Aug. 17. But Alissa Fox, executive director for legislative policy at the Blue Cross/Blue Shield (BC/BS) Association in Washington, DC, says at least two major questions that are still outstanding.
The first issue is whether it’s necessary to follow certain guidelines completely or whether those advantages can be achieved through another method, says Fox. Likewise, she says it is unclear whether future innovation will be hampered. "We don’t have answers to these questions," reports Fox, who says BC/BS is currently assessing the rule in terms of its costs and benefits.
According to Donna Holmes, vice president for Health Insurance Portability and Accountability Act (HIPAA) services at First Consulting Group (FCG) in Chicago, the first step for providers should be a thorough assessment of where the organization stands, its compliance obligations, and available resources. She warns that health care organizations should be skeptical of vendor claims to be "HIPAA-compliant" since rewriting software may take several months.
In addition, Maria Ward, a senior consultant and HIPAA specialist with FCG, recommends that providers implementing HIPAA take the following steps:
Be aware that, since HIPAA addresses security, medical, and nonmedical code sets, electronic data interchange (EDI) transactions, privacy and standard identifiers, assessment is a major project affecting both the information technology (IT) and business areas of every organization, requires multidisciplinary skills, and should be led by a senior business executive, coordinating IT, security and privacy managers, key operational areas, and any outside expert resources.
Ask themselves if their current EDI translator software will be able to handle the added transaction volumes that will result from implementing HIPAA standards.
Conduct a detailed mapping analysis between current formats and the X.12N HIPAA Implementation Guides, and be prepared to address any discrepancies they may find.
In the case of health plans, consider setting up a centralized testing unit since they will be working with many trading partners.
Consider whether use of a clearinghouse is an appropriate approach, but be aware of possible limitations of third-party clearinghouses, which can address the format of transactions more easily than content.
Know how to propose changes to the EDI standards through the Designated Standards Maintenance Organizations.
Consider participating in, or at least monitoring, the activity of the Standard National Implementation Process (SNIP) now under way. SNIP will provide a broad set of guidelines for all areas of HIPAA implementation.
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