Greg, For what it's worth, I believe CMS representatives have been invited to an American Optometric Association sponsored meeting next month for members of the vision industry. It will be interesting to hear their thoughts on this. The additional confusion we have around code sets for eyewear plans has put our provider software community even further behind schedule.
In fact, returning to the "version control" thread for a minute... vision CEs may well be faced with a MUCH more serious problem than possibly having to support both a "version A" and "version B" of a standard for awhile. Given the fundamental nature of our codeset problems, the version required on 10-16-03 just, flat doesn't work. If a "version B" compromise that DOES work for payors is identified...shepherded through the DSMO... the NPRM process... etc. etc., it still might be years before we can even use it on a voluntary basis... because it will still be technically different from the current standard.... maybe not different enough to break anyone else's adjudication system, but different enough to require the receiver to "relax" his compliance checker rules. Some sort of "Papal Dispensation" may be needed to permit the vision industry to use a later (i.e., not-yet-required or not-yet-approved) version of the standard, as soon as it can be considered "closed for comment" within X12. -Chris At 08:50 PM 4/14/02 -0500, Koller, Greg wrote: >Chris, > >I concur. > >Every time I meet with a provider they start looking like deer in the >headlights when I try to explain this. Part of the problem is the number of >vendors out there consistently telling them they will be compliant. I am >not so sure the vendors are far off with their understanding. Yet, we >continue to see major payers that are not yet at the point of introducing >anything. The all or nothing concept with HIPAA is going to be devastating >to these providers, because they do not understand the additional data they >will be required to collect. > >As a clearinghouse, we have advocated strongly for the staged approach. >Start publishing elements that are required and setting timeframes for them. >I think the biggest step for most entities will be moving from a flat NSF or >HCFA to a Looping ANSI, 4010 but not compliant. Payers should be doing that >- NOW! Next, start asking for and setting timeframes for the required >elements, specifically those that are readily available or relational to >current data. Lastly, set timeframes for non-relational and >optional/situational data that the payer will require. That basically >brings us to compliance. This will not only start getting reasonable efforts >made towards compliance, but it will educate the providers on what is at >hand as we go along. I think the perfect opportunity to make such a method >viable would be to have CMS take the lead in such a program. > >Just a theory. > >Greg Koller >Manager of Operations and Business Development >United Wisconsin Proservices >(414)226-5520 >[EMAIL PROTECTED] > > > > -----Original Message----- >From: Christopher J. Feahr, OD [mailto:[EMAIL PROTECTED]] >Sent: Saturday, April 13, 2002 1:07 PM >To: [EMAIL PROTECTED]; George Kaye; [EMAIL PROTECTED] >Subject: Re: Code Set effectivity compliance testing > >Kepa, >Has there been any discussion of the mechanism (and where its funding might >come from) by which providers' software vendors can be EDUCATED regarding >this critically important issue? I have not met a single Office Management >System vendor yet who understands that even if the X12 EDI messages are not >going to be flying right out of the doctor's software, the required data >elements for populating an 837 DO have to be in there and WILL have to be >packaged up and handed off at some point to a "translator engine/entity" >for conversion to the standard. I doubt that more than 5% of the OMS >vendor community gets it that NONE of the old claim standards map reliably >and consistently to the new HIPAA standards, and that sending NSF and "1500 >print images" to a clearinghouse is NOT going to be much help to the >doctor. Unless CHs and payors are prepared to massively "relax" these >standards for awhile, we will be looking at a 90% reject rate for claims >from small providers. This global misunderstanding (they don't even know >that they don't know) may explain why almost no software vendors or doctors >are coming to X12 meetings or asking questions about this... only a year >before they are supposed to be in "testing mode". > >(And if you think the OMS community is out of the loop on TCS standards, >try asking a few doctors what they know about this! I'm doing a primarily >TCS-related HIPAA presentation to 50 or 60 eye doctors in N. Calif. next >week and they are pretty excited about hearing this. To date, all doctors >have heard/read about HIPAA is the Privacy Rule. They just assume that >their OMS vendors are wiring the TCS stuff into their next system upgrade.) > >Regards, >Chris > >At 09:56 PM 4/8/02 -0600, Kepa Zubeldia wrote: > >George, > > > >That is a very interesting point. Is your assumption that the >clearinghouse > >creates the transactions and has control of the code sets? The fact that >the > >clearinghouse has demonstrated the "capability" to use a certain code set > >does not necessarily mean that each one of the providers clients of that > >clearinghouse is using that same code set. I wish life was that easy. > > > >One of the typical "HIPAA Myths" is that the clearinghouses can magically > >make the providers compliant. That is not the case. Let's make sure that > >all the players understand what is their own responsibility. If the > >expectations from providers are that their vendor or clearinghouse will >take > >care of HIPAA much like they took care of Y2K, we will run into big >problems > >when they wake up to the reality. > > > >Kepa > > > > > > > > > >On Monday 08 April 2002 02:58 pm, George Kaye wrote: > > > If a payer performs compliance testing with a clearinghouse for code set > > > effectivity for a professional claim (for example), has anyone thought > > > through the process of what that testing should consist of, so that the > > > payer can assume that those code sets will continue to be compliant from > > > that clearinghouse on an ongoing basis regardless of: the type of > > > professional claim (office visit, ambulance, physical therapy etc.), or > > > when the code is impacted by new code set releases by the DSMO's? > > > >To be removed from this list, go to: > >http://snip.wedi.org/unsubscribe.cfm?list=business > >and enter your email address. > > > >The WEDI SNIP listserv to which you are subscribed is not moderated. The > >discussions on this listserv therefore represent the views of the > >individual participants, and do not necessarily represent the views of the > >WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official > >opinion, post your question to the WEDI SNIP Issues Database at > >http://snip.wedi.org/tracking/. > >Posting of advertisements or other commercial use of this listserv is > >specifically prohibited. > >Christopher J. Feahr, OD >http://visiondatastandard.org >[EMAIL PROTECTED] >Cell/Pager: 707-529-2268 > > >To be removed from this list, go to: >http://snip.wedi.org/unsubscribe.cfm?list=business >and enter your email address. > >The WEDI SNIP listserv to which you are subscribed is not moderated. The >discussions on this listserv therefore represent the views of the individual >participants, and do not necessarily represent the views of the WEDI Board >of Directors nor WEDI SNIP. If you wish to receive an official opinion, >post your question to the WEDI SNIP Issues Database at >http://snip.wedi.org/tracking/. >Posting of advertisements or other commercial use of this listserv is >specifically prohibited. Christopher J. Feahr, OD http://visiondatastandard.org [EMAIL PROTECTED] Cell/Pager: 707-529-2268 To be removed from this list, go to: http://snip.wedi.org/unsubscribe.cfm?list=business and enter your email address. The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. Posting of advertisements or other commercial use of this listserv is specifically prohibited.
