Beyond Colorado A standardized code-editing system could potentially save billions of dollars currently spent in the United States annually on the claims reconciliation process. A standardized system would not only allow physicians to significantly increase the number of claims payments that could be automatically posted by their practice management systems, it would also allow physicians and other healthcare professionals to apply a more robust claim scrubber to increase the likelihood that claims are submitted accurately the first time, thus eliminating significant rework for both physicians and payors. Although the Medical Clean Claims Transparency and Uniformity Act applies only to claims within the state of Colorado, the task force is working toward expanding this work to a national level. Several additional states, recognizing the collaborative work and widespread participation in the task force, have expressed interest in the Colorado initiative. Of note, Vermont is now actively engaged with the Colorado task force and plans to utilize its work on standardization to promote uniformity of claims within the state. Additionally, the Affordable Care Act (ACA) requires the Department of Health and Human Services (HHS) to “investigate whether there could be greater transparency and consistency of methodologies and processes used to establish claim edits used by health plans … It is believed that uniform edits could improve the quality of comparability across multiple payors in an all payor claims database, and simplify claim submission compliance for providers.” In recognition of the enormous work that has been completed in this area by the Colorado initiative thus far, the task force is working to receive HHS recognition and approval as an ACA pilot program. A Case for Savings Physicians, payors, patients, and the healthcare industry can save billions of dollars annually by increasing the efficiency of claims adjudication. In order to realize such savings, the industry must eliminate the opacity and complexity that permeates the current payment system. Adoption of a standardized claim edit system is a crucial step toward that end. Therefore, the AMA calls on all stakeholders to support the Colorado Clean Claim Task Force initiative. ■ For additional information on the Colorado initiative, visit www.hb101332taskforce.org. To learn more about the AMA’s administrative simplification advocacy and related resources, visit www.ama-assn.org/go/simplify. THE JOURNAL OF THE HEALTHCARE BILLING AND MANAGEMENT ASSOCIATION 21
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