(July 20, 2010) Jerry Killough, CEO of Clinix MIS testified before the National Committee on Vital and Health Statistics (NCVHS) on behalf of the Healthcare Billing & Management Association (HBMA).
The NCVHS serves as the public advisory body to the Secretary of Health and Human Services in the area of health data and statistics. The hearings of the committee focused on gathering information for the establishment of a national identifier for health plans and the identification of operating rules to support standard transactions for eligibility and claims status.
Mr. Killough acknowledged 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 meet the congressionally mandated date for implementation.”
Mr. Killough’s testimony brought to the committee the reality and complexities that medical billing companies and physician practices face. His presentation outlined several concerns about the operating rules, including:
- The health plan community’s ability to meet implementation deadlines with adoption of the ANSI 4010 format, and the imminent transition to new ANSI 5010 standards.
- The financial complications and costs for providers who get caught in claims disputes between patient and health plan provider.
- 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.
- The complications arising from the widespread use of companion guides.
Mr. Killough went on to make recommendations for how operating rules should address these concerns, including:
- Allowing implementation 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.
- Establishing a system that includes a machine that can read all health plan swipe cards.
- Eliminating the use of companion guides completely.
With the imminent adoption of new standards under HIPAA, the NCVHS is required to make recommendations to the Secretary of Health and Human Services (HHS) for operating rules for both eligibility and claims status. The Secretary will then mandate a single set of operating rules for each transaction, toward establishing standardization in the exchange of electronic information.
Clinix Medical Information Services LLC is a leading provider of Software as a Service (SaaS) based software, delivering Practice Management Solutions and Electronic Medical Records systems to medical billing companies and physician practices across the United States. Clinix solutions increase efficiency, improve collection and enhance record keeping while limiting start-up and upgrade costs. For more information, please visit www.clinixmis.com or call (866) 254-6496, ext. 102.