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How to work out kinks in the beneficial paperless attachment system

HIPAA Training Advisor, April 20, 2006

HIPAA TRAINING ADVISOR
Brought to you by HCProfessorT
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Volume 2, Issue 8

Thursday, April 20, 2006

HIPAA TRAINING ADVISOR is a free, biweekly e-mail newsletter of tips and information on training your healthcare staff on HIPAA noncompliance.

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Mandatory compliance of the HIPAA privacy regulations, including the training requirement on your organization's policies and procedures, took effect April 14, 2003. And organizations must implement a security awareness and training program NOW, to comply with the final security rule. For more information about how to fulfill HIPAA's training requirements, contact Dave Miller at davemiller@hcpro.com. For more information on HIPAA's changes to consent, authorization, and other issues, click here: http://www.hcpro.com.

As your organization awaits the final claims attachment rule, there is good news: A proof-of-concept pilot showed that the attachments are workable and generate savings for both payers and providers. The pilot recommended changes to the proposed rule but found that adopting the electronic attachments could produce immediate benefits.

"We successfully demonstrated the use of electronic transactions in the exchange of additional records and information," said Suzan Ryder, director of electronic commerce and Part A systems for Empire Medicare Services (EMS) in Syracuse, NY, during the January 25 CMS audioconference, "Electronic Claim Attachment: Pilot to Operational." Ryder helped EMS direct the five-provider pilot.

The pilot proved that electronic claims attachments work, but it also showed that the rule may need adjusting. EMS found that the six attachment types would not meet 100% of its medical review needs and suggested additions for hyperbaric oxygen treatment and several other clinical areas. Providers recommended that CMS issue guidance on responding to multiple LOINC® request codes with one image or CDA attachment.

But even with an appropriate final rule, the transition will likely vary by provider. Ryder offered the following advice to prepare for the electronic claims attachment final rule:

1. Analyze your claim attachments. Determine which types of attachments (e.g., clinical reports and rehabilitation services) you will use, what your payer typically requests for nonclinical data, and how specific current payer requests are.

2. Use resources to supplement your current transaction knowledge. You've probably become familiar with HIPAA transactions such as the 837. Using the attachments requires that you learn new information (e.g., extensible markup language and the HL7 standards). The transition process will be smooth if both the technical and clinical sides of your organization understand the new material, Ryder said.

   Helpful publications include the ASC X12N Additional Information to Support a Healthcare Services Review (275) Implementation Guide, ASC X12N Healthcare Claim Status Request and Response Implementation Guide, and HL7 CDA Standard Release 1.0. HL7 will also provide an Additional Information Specification Implementation Guide for each attachment type.

3. Communicate with payers. Decide beforehand whether you'll use solicited or unsolicited claims attachments. "Do you have cases [in which] the payer is always asking for an attachment for a certain claim situation?" Ryder asked. If so, identify these situations and speak to the payer about using unsolicited attachments to streamline the process.

Editor's note: Go to www.empiremedicare.com/hug/ecapfiles/ecapindex.htm for more information about EMS' electronic claims attachment pilot. This article was adapted from "Electronic claims attachment pilot shows promise," Briefings on HIPAA, April 2006.

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