• E-mail
• Print
• RSS

Compliance with the HIPAA transactions rule requires operational changes

HIM Connection, May 20, 2003

Want to receive articles like this one in your inbox? Subscribe to HIM Connection!

Dear Colleagues:

To achieve the benefits of the new HIPAA transactions and code sets standards, providers must not only acquire the information technology capability to support the standards, but also make some significant changes in operations.

Most notably, providers will have to consider the following:

• Where in the work flow the transactions will be performed
• How to manage the increased quantity of data received electronically
• What changes are needed in staff qualifications

Many providers are conducting revenue cycle enhancement projects which entail, among other things, moving more of the eligibility verification and pre-certification process to the time of admission/registration, or even beforehand. However, many of these projects are being conducted outside of the scope of the HIPAA transactions project, so neither the benefits of the HIPAA transactions, nor the reality of changing data requirements are considered. If taken together, providers may identify additional needs for information technology support and can better coordinate changes in job functions from both activities.

You'll need to enhance your facilities' systems capabilities. For example, it is not sufficient to deliver an eligibility response on a separate screen--where staff can manually transfer information to another screen, or print it out and file it in a billing folder--because it takes too much time to re-enter the data. Populating notes fields in an admission/registration screen is better than nothing, but even this will not significantly improve matters, especially if the data cannot be processed in some form of decision support. Ideally, the data from an eligibility inquiry or other transaction should flow directly into specified fields to provide an alert, restrict or permit other actions based on its value, and eliminate re-keying in another transaction. Interface the information so that the most current data updates a master person index and is available for use in other transactions, when needed.

Mangers may need to reorganize, retrain, and better equip staff to take advantage of the more complete and accurate information received with the new transactions. When admission or registration staff do not appropriately screen patients for eligibility, patient accounting staff have to do it later. However, these employees are typically busy solving problems created by denied claims. And thus the cycle perpetuates itself.

The new book and companion CD-ROM, HIPAA Transactions Made Simple: Achieving the Benefits of EDI, provide a step-by-step plan to help you adopt the new HIPAA transaction standards and use the changes to your advantage. Regardless of the health care setting you work in, HIPAA Transactions Made Simple offers a chapter-by-chapter process for transactions implementation.

Click here for more information or to order your copy.

Sincerely,

Laura Motta
Editorial Assistant

Want to receive articles like this one in your inbox? Subscribe to HIM Connection!

• E-mail to a Colleague
• Print
• RSS
• Archive