This is an interesting conversation, under HIPAA will providers no longer be sending their Usual & Customary billings to the Payors? Currently in our state the Providers are required to bill using their U&C amount and the R/A returns the contract amount, adjustments and net paid.
We have been looking into the possibility for providing repricing services to our providers, but couldn't see a real benefit. If HIPAA requires the provider to bill the contract rate rather than the U&C, I begin to see the value of the service. Looking forward to more discussion on this issue.... > But can it be a clean claim if it bills beyond the contractual > amount allowed by the health plan? I don't think so! > > If that is what this letter says, I would like similar things > done at my job!! > > Basically, I can ask for any salary as long as it is in the > correct format/protocol... > > That is what COULD be taken from this letter... > > Now if the AHA is saying if we put in the proper (contractually agreed > upon) amounts and values in the correct format we should get prompt > payment without haggling from the insurance plan, that sounds OK to > me... > > But then how will the provider be able to PROVE that they provided the > service they are billing for.. Guess that is fraud the same way we > have it right now.... > > -----Original Message----- > From: Rachel Foerster [mailto:[EMAIL PROTECTED]] > Sent: Friday, May 03, 2002 4:11 PM > To: [EMAIL PROTECTED]; 'WEDi/SNIP ID & Routing' > Subject: RE: FW: Article > > > David, > > Interesting letter from the AHA to HHS. A thorough reading of the > letter makes clear that what the AHA is asking HHS to do is declare a > HIPAA-compliant claim as a "clean" claim and thereby kicking in many > states' prompt payment acts for clean claims. To date none of the > state prompt pay acts define what a clean claim is. > > My personal opinion is that this request has a snowball's chance of > reaching any final rule status. If it were to do so, in effect the > feds would be requiring payers to pay any HIPAA-compliant claim > regardless of whether the services were covered services or not under > the health plan contract - or potentially whether or not the > individual to whom the services were rendered was even a > current/eligible enrollee under a given health plan contract, or any > other number of "business rules" that are applied during claims > adjucation. > > This could be tantamount to the feds requiring a HIBCC-compliant 810 > invoice must be paid, or even an AIAG compliant 810, or wouldn't this > be loverly...an 810 received from a federal supplier which complied > with the fed's 810 specification. > > Lastly, any potential HHS rule on this would most certainly have to > supercede any state law, and this too makes problematic, in my > opinion, that such a rule would reach final status. > > Rachel > > -----Original Message----- > From: David Frenkel [mailto:[EMAIL PROTECTED]] > Sent: Friday, May 03, 2002 2:43 PM > To: [EMAIL PROTECTED]; 'WEDi/SNIP ID & Routing' > Subject: RE: FW: Article > > > > This is an interesting article from yesterday's AHA news. > > Regards, > > David Frenkel > Business Development > GEFEG USA > Global Leader in Ecommerce Tools > www.gefeg.com > 425-260-5030 > > AHA urges HHS to require health plans to accept HIPAA claims AHA in a > letter today urged HHS Secretary Tommy Thompson to adopt a rule or > guidance requiring health plans to accept hospitals' claims compliant > with the Health Insurance Portability and Accountability Act. > According to the letter, one of the major administrative costs and > sources of frustration facing hospitals is frequent claim payment > delays, particularly by private payers. The final HIPAA regulation on > electronic formats and code sets established national standards for > electronic submission of claims, and makes clear that health plans are > not permitted to require additional elements that deviate from those > specified, the letter adds. Plans can be somewhat arbitrary in > processing, leaving providers facing payment delays and engaged in > "wasteful" resubmissions and reconciliation. The letter asks HHS to > clarify that plans must accept HIPAA-compliant claims for contractual > provisions with other entities covered under HIPAA and for state and > federal prompt pay requirements. The letter will be at > <http://www.aha.org>. > > > Del Texley LIPA Information Systems (541) 484 6430
