Del, Please don't confuse this "article", i.e., the AHA letter as having anything to do with **current** HIPAA requirements for electronic claims transactions.
The AHA letter is a **request** to DHHS. If/when DHHS decides to do anything with the request, it must 1) be consistent with the powers that DHHS has or which Congress has delegated to it, and 2) go through the federal rule making process. Thus, my opinion is that this letter is great for conversation, but very short on being anything concrete, if at all, for years. Rachel -----Original Message----- From: Del Texley [mailto:[EMAIL PROTECTED]] Sent: Friday, May 03, 2002 6:35 PM To: [EMAIL PROTECTED]; 'WEDi/SNIP ID & Routing' Cc: terry Coplin; [EMAIL PROTECTED] Subject: RE: FW: Article 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
