The Southern California Physician, April, 2002 |
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HIPAA: Start to Plan Now
April 14, 2003 is the first deadline for MD practices to comply with HIPAA. You are required to file a Compliance Plan by October 16, 2002 if you now use electronic claims submission. The deadline dates for HIPAA's Administrative Simplification Rules are as follows:
Testing must begin by April 16, 2003. Even physicians who do not have to file a plan can expect their software vendor and health plans to start testing before that date. However, all covered entities are free to implement the uniform transaction rule as soon as October 16, 2002. Finally, the Act provides that after October 16, 2003, all Medicare claims must be submitted electronically in HIPAA compliant transactions unless (1) no method is available to do so or (2) the provider (including physicians) making the claim has fewer than ten full-time equivalent employees. SBCMS and CMA believe the HIPAA transaction rule will hugely benefit physicians and hospitals. Despite our concerns about other aspects of HIPAA, we believe this particular rule is mainly a benefit for providers. For the first time, all health plans and other payors will be required to accept the same single form. Instead of over 400 variations in claim forms, there will be only a few, one for each type of transaction. There will also be uniform code sets that cannot be changed by local practice. This means possibly substantial savings for doctors who will not have to supervise a staff devoted to properly filling out multiple varieties of claim forms and attachments. According to CMA, one estimate based on a survey of 20 medical groups (most with eight or more physicians) shows the average potential benefit was $7200 per physician. Some physicians may choose to stop using a clearinghouse and submit claims directly to the payors under this simplified system. Those practices that do use clearinghouses should find their requirements much easier to meet and lower in cost.
Areas for Potential Savings Rejected Claims: According to the AMA, over 30 percent of all claims are rejected nationally. Of that number 30-40 percent are rejected for incorrect or missing ID. Half are never resubmitted. The new rules allow real time eligibility determination including IDs. Electronic Eligibility: Under HIPAA you will be able to submit electronic eligibility inquiries directly to the health plan to promptly determine eligibility. This should reduce claims rejected for these reasons. When HIPAA transaction set rules go into effect in October 2003, each plan will have to provide this service. Electronic Verification of Receipts: The rules will also allow electronic documentation of claims receipt so that the excuse "we never got it" won't be heard. Referrals: Current estimates are that manual referrals cost primary care providers about $40 each and their specialist counterparts about $20. Going online with new standard 278 (Referral and Authorization) will result in large savings.
By starting to plan now, physicians will be able to reap the most benefit from the new rules on uniform transactions. Physicians who are ready will be able to realize benefits long before the end of 2003 when everyone who participates in electronic transactions will have to comply. Planning now will prevent last minute panic when the deadlines do arrive. You will want to be sure that office equipment and software are consistent with HIPAA requirements. Enhancing your security and privacy procedures will also reduce the risk of and liability for unauthorized disclosures. HIPAA will not change how you practice medicine; it will change how you create, handle, store and transmit medical records and claims. It will change how you interact with patients and will require better record keeping. It will require you to obtain training for yourself and your staff and it will require planning. It will require you to substantially tighten your computer security. Fully adopting the HIPAA requirement makes good business and economic sense for doctors. CMA has embarked on a long-term educational strategy that will allow physicians to implement HIPAA in their offices in manageable monthly stages. In addition, and in support of these seminars, CMA will publish guide materials for the benefit of CMA members. An important document available from CMA's Center for Legal Affairs is "HIPAA Compliance for CMA Members," a basic primer and a first step toward compliance for physicians in solo, small and mid-sized groups, and their key administrative personnel. The guide addresses why HIPAA can save you real money and make your practice more efficient. It is free to members - a .pdf version can be downloaded from CMA's website at www.cmanet.org (Members Only Section). On May 21, 2002, SBCMS, RCMA and CMA will host "HIPAA without the Hype: a Practical Approach to HIPAA and EMR." The half-day seminar is presented by Steven Fleisher, JD, attorney and HIPAA Consultant to the CMA and Patricia Lohman, President of Outlook Associates, a Healthcare Information Technology Consultant. We will host the seminar in our Conference Room. Seminars will be discounted for SBCMS/RCMA/CMA members. Steve Fleisher will also present a one-hour CME lecture: "HIPAA: An Introduction You Can Trust!" for medical staffs and other physician groups. Programs sponsored by CMA Organized Medical Staff Section (OMSS) members will receive a discounted fee. Please contact Steve directly if you are interested in arranging a presentation at your hospital or physician group: (415) 882-5159 or sfleisher@cmanet.org. By late 2002, CMA will provide SBCMS/CMA members a CD containing training tracks for physicians and for their staff, procedures for a gap analysis for regulatory compliance, policies and procedures and forms to help move members to operating their practices in compliance with HIPAA. Again, CMA members will receive discounted rates. SBCMS will keep you informed on a regular basis. Additional sources
of information include the HIPAA Resource Center on the CMA web site,
www.cmanet.org in the Members Only section, or you may contact CMA's
Legal Help Line at (415) 882-5144, or via e-mail at legalinfo@cmanet.org. |
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