HBMA Participated in National Committee on Vital and Health Statistics Hearing

Last week, two presenters representing HBMA testified at the National Committee on Vital and Health Statistics’ annual hearing of its Subcommittee on Standards. The two testimonies covered provider enrollment claim edits as they relate to section 10109 of the Affordable Care Act.

Dave Nicholson, CHBME, president and CEO of Baltimore-based medical billing and practice management company Professional Management, Inc., delivered the first testimony on behalf of HBMA, in which he discussed provider enrollment issues such as:

• Differentiation between enrollment and credentialing processes, including the recommendation for standard definitions;
• Issues created by the number of different provider forms that exist and the need for streamlining the enrollment process;
• The possibility for a shared enrollment system;
• The different data compiled by each health plan and the possibility of consolidating data; and
• The prevalence and inefficiency of paper forms in the enrollment process.

In the second HBMA presentation, Holly Louie, RN, CHBME, PCS, compliance officer for Practice Management, Inc., covered the challenges of claims coding that arise when each payor abides by a different set of rules. Louie discussed common issues, such as incorrect claim adjudication, improper payor requirements, denials for add-on codes, unpublished bundling edits and unlisted services, and provided analysis based on incidents that have taken place at her company.

You can view the schedule of the testimony, participant's testimony, and/or to obtain the Internet Broadcast Link at the NCVHS website.