"Complaining" is MUCH more expensive for providers than "submitting". I am in my 4th consecutive year of complaining loudly and incessantly about the non-HIPAA requirements being imposed on providers by commercial and Medicaid vision plans. It's clear now that most will continue... "business as usual"... post-October. Why should I believe that complaining after 10-16 will be any more effective?
But folks, this is what you get when *regulation*, rather than economic common sense, is intended to drive large enterprises to treat smaller ones fairly. There IS a way to make common sense the driver. It's conceptually very simple, but will require [even more] hard work and a willingness to let go of some old paradigms. No amount of effort or wishful thinking will make the present Spruce Goose fly any farther or more efficiently than the original one flew. It will be far easier for us to build a new airplane at this point. California Medicaid has decided to push vision claims and certain other product lines to an unspecified time "after October" (see: http://files.medi-cal.ca.gov/pubsdoco/pubsframe.asp?hurl=/pubsdoco/publications/bulletins/hipaa/hipaanews20030313.htm#L2 ) , from which the following is quoted: "Medi-Cal is making every effort to comply with the federally mandated Health Insurance Portability and Accountability Act (HIPAA). However, some of the HIPAA transactions and code set projects will not meet the October 16, 2003 implementation deadline. The following information describes what components of the HIPAA standards Medi-Cal will and will not implement by October 16, 2003. Providers must continue to follow existing billing instructions until otherwise notified in future Medi-Cal Updates. To accommodate the size and complexity of the transaction and code set projects, Medi-Cal will implement the HIPAA standards in multiple phases, which will extend beyond the October 16, 2003 compliance deadline. Therefore, it is important for providers to review monthly Med-Cal Updates over the coming year for detailed HIPAA billing instructions and implementation schedules." Three months ago our largest commercial vision plans and the 50-state MediCaid consortium (NMEH) submitted a joint request to CMS for about 30 new eyeglass codes and modifiers for describing eyeglass components on health claims. Information about how to use these codes is critical to any provider wanting to assert his right to bill vision plans with an 837 (versus hand typing on proprietary DDE screens). Four mos. from H-day, however, the industry still has only deafening silence from our largest commercial plans... and palliative assurances that everything will be "HIPAA compliant"... not to worry! Something this pandemic cannot be treated by filling out a "complaint" form on a CMS web site. Best regards, -Chris Christopher J. Feahr, O.D. Optiserv Consulting (Vision Industry) Office: (707) 579-4984 Cell: (707) 529-2268 http://Optiserv.com http://VisionDataStandard.org ----- Original Message ----- From: "John W. Carter" <[EMAIL PROTECTED]> To: "WEDI SNIP Testing Subworkgroup List" <[EMAIL PROTECTED]> Sent: Thursday, June 12, 2003 9:24 AM Subject: RE: your post on submitting clean transactions Kepa, I have "complained" about frivolous requirements and erroneous edits for about two years. Payers and certification companies have these problems. A "revolt" won't help. With little time left, a more practical idea needs to be considered. John W. Carter > -----Original Message----- > From: Thaler [mailto:Thaler] > Sent: Thursday, June 12, 2003 10:56 AM > To: WEDI SNIP Testing Subworkgroup List > Subject: RE: your post on submitting clean transactions > > > Too bad we have to use the word revolt - but some entities > only learn through education that is "enforced". There is a > complaint form at > > https://www.cms.hhs.gov/hipaa/hipaa2/support/correspondence/co > mplaint/default.asp? > > Patrice > > -----Original Message----- > From: Kepa Zubeldia [mailto:[EMAIL PROTECTED] > Sent: Thursday, June 12, 2003 10:08 AM > To: WEDI SNIP Testing Subworkgroup List > Subject: Re: your post on submitting clean transactions > > > Jeff, > > You ought to complain about this! The problem is that if > nobody complains, it > will never get fixed. Providers need to start a "revolt" > against these > frivolous companion guide requirements. The fragmentation of > the standards > into "custom" versions is probably one of the biggest threats > that HIPAA has, > and one of the many reasons why the implementation is going so slow. > > Kepa > > > > > On Thursday 12 June 2003 06:49 am, [EMAIL PROTECTED] wrote: > > Kepa, > > > > As a provider, I'm seeing quite the opposite of what you > say about clean > > transactions, here in the real world. > > > > Regardless of the fact that federal regulation require a > payer to accept > > a clean X12 claim, they will do what works for them. Our > local Medicare > > carrier has been pretty good at sticking with the IG, but > the local Blues > > here came out with a 2" thick binder for the companion > guide documents. > > Many of the segments are in absolute contradiction to the > IG. When I > > called them on this, the response was simple...."follow the > companion > > guide, or else the claims will get bounced on the front end > edits. And > > since the front end edits are done before the claim enters > our processing > > system, if its noncompliant, it doesn't get into the > system." (Legal > > speak for "we never got your claim".) > > > > Never bothered to complain to CMS, as I need to get paid; > not worry about > > the IG implementation. For most small providers, the 800 > lb gorrilla > > leads the way. > > > > The software just winds up with a lot more conditional > branches that it > > should have, but the cash flow continues. We've been > sending X12 claims > > to Medicare and Blue Shield now since April, with no problems so far > > (knock on wood). > > > > Jeff Pinsky > > PTFILE Systems > > > --- > 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/. These listservs should > not be used for commercial marketing purposes or discussion > of specific vendor products and services. They also are not > intended to be used as a forum for personal disagreements or > unprofessional communication at any time. > > You are currently subscribed to wedi-testing as: > [EMAIL PROTECTED] > To unsubscribe from this list, go to the > Subscribe/Unsubscribe form at http://subscribe.wedi.org or > send a blank email to [EMAIL PROTECTED] > If you need to unsubscribe but your current email address is > not the same as the address subscribed to the list, please > use the Subscribe/Unsubscribe form at http://subscribe.wedi.org > N4zrryjNyzz�vzz > j|y!<?y!<jjyNzzurzjr~rrvrz{zj~zzzrjrz?mjjnnRnbujjyz > ??ryrz?izjizvynRn --- 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/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-testing as: [EMAIL PROTECTED] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org --- 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/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-testing as: [EMAIL PROTECTED] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org
