Healthcare Billing & Management Association Plays Key Role in National Committee on Vital and Health Statistics Hearing
07/29/2010
Panel discussion focuses on establishment of operating rules for
eligibility and claims status
LAGUNA BEACH, Calif. – July 28, 2010 – 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.
About HBMA
A non-profit, member-led trade association, the
Healthcare Billing & Management Association (HBMA) represents more than
30,000 employees at well over 650 third-party medical billing firms. Annually,
HBMA companies submit more than 350 million initial claims on behalf of
hospital-based physicians, office-based physicians and other allied healthcare
providers. Founded in 1993, HBMA and its members foster personal development,
advocate on the behalf of the profession, and promote cooperation through a
wide range of business resources, educational events, networking opportunities,
certification programs and adherence to the Medical Biller’s Code of Ethics. As
the only trade association representing the interests of medical billers in
Washington D.C., HBMA works with legislative stakeholders and federal agencies
to improve the business of medical billing and the practice of healthcare.
Learn more about how HBMA is elevating the medical billing profession at www.hbma.org.
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Press contact information:
Dave Anderson, Dodge Communications, (770)
576-2547
danderson@dodgecommunications.com
Brad Lund, Executive Director, HBMA, (877)
640-4262
