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The Health Insurance Portability and Accountability Act of 1996 (HIPAA) aimed to reduce inefficient paper claims submitted to multiple payers using different medical coding sets, such as those required for home infusion therapy. The final HIPAA regulations published in August 2000 adopted some key recommendations by the National Home Infusion Association (NHIA), and standardized electronic claims for home infusion therapy will be in place by October 2002.
"While it is now widely accepted to pay for home infusion services on a per diem basis, the lack of standardized coding sets and lack of electronic claiming increases the overall cost of home infusion services," according to a NHIA spokesperson. Home infusion therapy is estimated to be a $5 billion industry, with overall savings to the health care system estimated at more than $12 billion. The regulations require payers and providers to be able to support electronic claims transactions without requiring all claims be handled this way. In the future, however, paper claims may use the codes set as standards for electronic data interchange (EDI).
In the final regulation, the Department of Health and Human Services endorsed four national coding sets — CPT codes, used primarily for physician services; HCPCs, used primarily for medical products and equipment; ICD-9s, used for diagnoses and select medical procedures; and NDCs, which assign a unique code for each drug from each manufacturer — will replace "J" codes, which will be eliminated.
The ASC X12N 837 code will be the electronic transmission standard for professional pharmacy claims, including home infusion therapy; only retail pharmacies will use a NCPDP format.
Home infusion is still covered under "local" payer-specific and "custom" codes, which now must be standardized to comply with HIPAA. The NHIA endorses adopting as a national standard its Home Infusion EDI Coalition (HIEC) codes, which it says have widespread industry support. The codes were developed by a coalition of providers and payers, and are used by multiple payer organizations.
"Through HIEC, the association will continue to work to advance standardized electronic claiming for home infusion, which will benefit payers and providers alike," said Bruce E. Rodman, the HIEC committee chair. "For the first time, this goal appears to be within reach, and the cost savings will ultimately be significant."