Health Information Management

Contact vendors about compliance with HIPAA transactions standards

HIM Connection, July 16, 2003

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A crucial step in preparing for the October 16, 2003 HIPAA transactions and code sets deadline is finding out what your vendors are planning to do. Take an inventory of your systems and contact each vendor to determine how it is approaching the HIPAA transactions, when it will be ready to supply claims transactions support, and whether it will support full compliance.

Taking an inventory of your systems prior to contact the vendors is very important for two reasons:

  • There may be more billing systems than you first realize. A hospital clearly has a hospital billing system. But it is not unusual for it to also have one or more billing systems for home health, hospice, ambulatory surgery, outpatient clinic, emergency medical transport, durable medical equipment, diagnostic imaging, long-term care, behavioral health care, and so on. A hospital may own several physician practices, each with its own billing system or each contributing to yet another centralized billing system. It may get even more complicated, as the centralized physician billing system may serve as a clearinghouse for other physician offices or other providers. It is even conceivable that a hospital has its own health plan, in which case it must adopt the standard transactions or use a third party administrator.

  • There may also be source data systems (or "feeder systems") that contribute directly to the billing system, should contribute to the billing system but do not currently, or also use the code sets and identifiers mandated by HIPAA. There may also be systems that are noticeably absent that would significantly contribute to improved productivity. Many providers' billing systems do not receive electronic remittances. As a result, data must be manually keyed into the billing system to support information from the remittance advice for coordination of benefits. Claims status may be given over the phone from printouts of the accounts receivable system. Eligibility verification and referral authorizations may have to be entered manually into systems after this information has been obtained from a Web site.

    At a minimum, the vendor inventory compiled to obtain information on the status of HIPAA transactions should include all billing and source data systems. This inventory may draw from the Y2K inventory and the inventory of systems with protected health information (PHI) for HIPAA's privacy and security readiness assessment.

    There are a variety of approaches to obtaining information from vendors. Start by reviewing the user-only page from the Web site. Some vendors will post an abundance of very detailed information on their Web site; others will not. When a vendor Web site lacks sufficient information or where there may be specific, additional questions, you must contact them directly. Depending on the urgency, a call or letter to its account representative is in order. In addition, attending user group meetings, audioconferences, or Webcasts sponsored by the vendor can be very helpful.

    No matter which approach you take to obtain information, it is always best to identify in advance what information you need. If your facility is managing many billing and source systems, it may be appropriate to record the results on a vendor inventory spreadsheet. Over time, this spreadsheet can be used to ensure that regular upgrades are applied when the transactions are modified and additional source systems (that are ultimately interfaced with the billing system) are added.

    This week's HIM Connection was excerpted from the book, "HIPAA Transactions Made Simple: Achieving the Benefits of EDI." Go to for more information or to order your copy.

    Sincerely,

    Laura Motta
    Editorial Assistant
    lmotta@hcpro.com ____________________________________________________



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