RE: Letter from AHA to CMS: or the HIPAA EDI Train Wreck

[Rachel Foerster]

Title: Message

I spoke on this subject today at the HIPAA Summit West and I briefly referenced the AHA letter to HHS. My personal opinion is that while in theory, their proposal makes sense, it's not really feasible or implementable.....especially in the less than 5 months remaining. I don't know of any payer's system that can calculate these averages, track what's coming in, audit it, generate a payment and then control it all so that at the end of some fiscal period it balances out. This could be more of a financial nightmare than today's average of 3-5% lost net revenue to due denied/rejected claims.   If you're interested, you can download my presentation from http://www.hipaasummit.com, follow the link to Agenda and then Day 1, scroll down to find me.   Rachel     Rachel Foerster Rachel Foerster & Associates, Ltd. Ideas - Promotion - Innovation Voice: 847-872-8070 email: [EMAIL PROTECTED] http://www.rfa-edi.com -----Original Message----- From: David Frenkel [mailto:[EMAIL PROTECTED] Sent: Thursday, June 05, 2003 9:48 AM To: WEDI SNIP Transactions Workgroup List Subject: Letter from AHA to CMS CHICAGO (HIPAA Wire) Are you ready for what the Oct. 16 Health Insurance Portability and Accountability Act transactions and code sets standards deadlines will mean for your bottom line?             Anxious that glitches in the early phase of TCS compliance — or non-compliance — will lead to a cash flow disaster, a hospital group is pressing for back-up measures and aggressive preparation, particularly on the part of payors.             In a May 19 letter to the Centers for Medicare & Medicaid Services, the American Hospital Association proposes the “development of a system-wide implementation plan that clearly outlines remedial actions that every health plan must take to ensure that an adequate level of cash flow to hospitals is maintained as the field transitions to HIPAA standardized claims.”             The association worries that disagreements between providers and payors over what makes for a HIPAA-compliant claim will slow down the money stream and leave hospitals and other providers scrambling for cash.             The AHA also calls for pre-deadline, end-to-end transaction testing to ease the transition. Finally, the hospital group says CMS should require plans to identify what they think is wrong with rejected claims so providers can redo them quickly and efficiently.             Lesson Learned: Health care providers should brace themselves for possible bumps in the reimbursement road in the early stages of HIPAA TCS compliance. Jun 4, 2003, 15:07 Regards,   David Frenkel Business Development GEFEG USA Global Leader in Ecommerce Tools www.gefeg.com 612-237-1966   --- 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-transactions 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