HIPAA Regulatory Alert: Transaction standard is far from projected uniformity

The HIPAA transaction standards have not resulted in the uniformity and efficiency envisioned when HIPAA was adopted. That’s the opinion of the HIPAA Implementation Working Group, which were presented in testimony to the National Committee on Vital and Health Statistics. The group, which represents health care providers, vendors, and clearinghouses, said that for providers, clearinghouses, and many others, standards implementation has yet to result in any clear return on investment.

“The savings predicted by the Department of Health and Human Services of $29.9 billion in administrative expenses over a 10-year period beginning in 2002 are far from view,” they said. “To date, the costs of complying with the Transactions and Code Sets Standards have been significant, and there are no data showing that providers have experienced any return on their investment,” the group noted.

The Working Group said significant progress has been made in implementing a standardized electronic claim form through use of the 837 claim transaction.

As 837 use becomes routine, according to the testimony, the industry has begun to discuss implementation of standards for other transactions. Collaboration is increasing among many sectors of the industry to ensure standards have the utility and promote the uniformity envisioned by the law, the group said. In addition, providers and vendors are becoming more active in the standard setting process.

The Implementation Working Group said the benefits of adopting any transaction standard relate primarily to ways in which standardization improves a participant’s ability to receive useful detailed information in a timely, uniform, and cost-efficient manner.

“The 837 claim transaction, which has been the primary focus for the HIPAA transition, is bringing limited, if any, benefit to the provider community in part because significant payer-specific customization is still required,” according to the group’s testimony. “As the focus of implementation shifts to transactions through which health care providers can obtain useful information, the opportunity for a positive business impact from standardization grows. For example, providers expect to see financial benefit from timely and useful patient eligibility, remittance advice, and claim status information.”

The group said the degree to which standards implementation has a positive or negative business impact also depends heavily on whether the standards reflect the needs of those who use them. But the current standards do not address the business needs of the provider and vendor communities, due in part to the historically significant representation of providers and vendors in the standard-setting process and in part due to the limited understanding of how the standards would be used in practice.

“We should learn from these experiences and use them to strengthen the standard setting process,” the Working Group declared.