LAGUNA BEACH, CA – The Healthcare Billing & Management Association (HBMA), a non-profit educational resource and advocacy group representing third-party medical billers and billing professionals, recently participated in a hearing conducted by The National Committee on Vital and Health Statistics (NCVHS). Taking place at the Hamilton Crowne Plaza Hotel in Washington, D.C. last week, the hearings were hosted by the Subcommittee on Standards and focused on gathering information on the establishment of a national identifier for health plans, and the identification of operating rules to support standard transactions for eligibility and claims status.
 
The NCVHS invited HBMA to participate in the hearings alongside other industry participants and authors of standards and operating rules. As an advocate of the Administrative Simplification provisions included in the Patient Protection and Affordable Care Act, HBMA initiated discussions by outlining some of the problems that have arisen since the original Health Insurance Portability and Accountability Act (HIPAA) standards set out to simplify administrative processes.
 
Presenting on behalf of HBMA, Jerry Killough, CEO of Clinix Medical Information Services LLC acknowledged as admirable the Congressional mandate that operating rules should enable providers to determine an individual’s eligibility and financial responsibility for specific services prior to or at the point of care. “This is a laudable goal, and one which we strongly support,” noted Killough. “But we must also acknowledge our concern about the ability of the health plan community to implement the congressionally mandated standards by the current deadline.”
 
Focused on the realities of implementation, the HBMA presentation went on to outline several concerns about the operating rules, including:
·         The health plan community’s ability to meet implementation deadlines considering the current status of its adoption of the ANSI 4010 format, and the imminent transition to new ANSI 5010 standards;
·         The financial complications and costs for providers who attempt to determine patient eligibility for services when most health plans have not yet implemented the 4010 standards in a consistent manner;
·         The inability of providers to get immediate information about the status of claims processing;
·         The potential for confusion should machine readable health plan cards become reality, with no standardization of swipe cards or readers; and
·         The complications arising from the widespread use of companion guides.
 
HBMA also went on to make recommendations for how operating rules should address these concerns, including:
·         Allowing the implementation of the 5010 code sets to take place on a staggered timetable;
·         Establishing an instantaneous verification system by which healthcare providers can enter a patient’s health insurance identification information, and confirm health plan enrollment and financial information;
·         Implementing a system by which providers can electronically track the progress of a claim and receive regular updates on the status of claims;
·         Eliminating the use of companion guides completely.
 
NCVHS is charged with advising the Secretary of Health and Human Services (HHS) and making recommendations regarding operating rules for both eligibility and claim status as well as other electronic data interchange (EDI) standards for healthcare. The Secretary will then mandate a single set of operating rules for each transaction.