Study shows HIPAA compliance hurts pediatric coverage
HIPAA Weekly Advisor, August 22, 2005
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HIPAA has inadvertently resulted in reduced Medicaid coverage for child development services, according to a recent study from The Commonwealth Fund, a private foundation based in New York City. To comply with HIPAA, state Medicaid agencies must eliminate local payment codes, which may result in reduced levels of coverage for children for primary health and support services such as mental health services, early intervention, physical and speech therapy, home care, case management, and transportation, reports the foundation.
Solutions to this problem include
- continued involvement of pediatric health experts in HIPAA standardization
- the creation of a pediatric consensus panel to identify and refine standards of care for preventive and developmental services and translate these standards into HIPAA-compliant codes
- additional research to identify distinctions between what health insurance covers and which payment codes apply and to measure the impact of standardized codes on the types of developmental services pediatric physicians choose to provide
The report, How Medical Claims Simplification Can Impede Delivery of Child Developmental Services is based on findings from a 50-state, point-in-time review of readily available state HIPAA compliance documents conducted in December 2004. It examines HIPAA administrative standardization and the process of modifying the standardized codes and assesses the implications of HIPAA standardization for payment of Medicaid-covered early childhood preventive and developmental services.
Click here to read more.
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