- Aggregation of contracting costs
- Aggregation of communications (and security) costs
- Aggregation of expertise required to maintain payer-specific requirements (before, this was file formatting and local codes issues; post-HIPAA it will be "Companion Guide" specifications)
- Aggregation of testing, change management and code maintenance costs
- Proprietary value-adds (transaction archiving, data analysis, claims scrubbing, etc.)
- What if trading partner agreements could be standardized -- even automated?
- What if a secure message transport was used that didn't rely on external, point-to-point addressing schemes?
- What if, instead of incorporating the superset of all payer requirements, the standard eliminated arbitrary "one-off" variations? Or at least, handled such customizations internally, rather than requiring a manual remapping of an output file?
- What if the messaging format itself had some intelligence, encoded its own rules for use in machine-readable terms, rather than relying on external, non-automated rules like an implementation guide?
--------Original Message-----
From: Chris Brancato [mailto:[EMAIL PROTECTED]
Sent: Tuesday, June 03, 2003 14:32
To: WEDI SNIP Transactions Workgroup List
Subject: RE: Transition paperHarry,
I am confident we've discussed this at least several times. Pardon me if I misunderstand but, your note implies that this is a secret. I bring your attention to numerous documents at the national forum level that discusses this very issue. WEDI/SNIP, AFHECT, NCHVS, all note that this remains a concern. On that we wholeheartedly agree.
Please openly consider these points:
1) It remains to be seen if the direct submission model using a PMP package is cost effective and efficient for the provider.
2) It remains to be seen if the direct submission model using PMP is cost effective and efficient for the payers.
3) It remains to be seen if the "ditto" is profitable for both payer and PM software company.
Additionally, consider this. In any software you use, you don't actually buy it and own it. You might want to take a closer look at the End User License Agreement or EULA of the software you use to read this note. You purchased the right to use it. You do not own it. Who determines what is reasonable for a company who makes millions of dollars in investment to license a product that will enhance the revenue of the user?
Is not the author entitled to some revenue for the use of his or her intellectual property? OK...no more transaction fees. The vendor now sees that revenue dry up from his revenue stream and now the provider ultimately pays a higher price to use and maintain that software package. The same one the helps him do his accounting, helps keep track of his collections and his productivity, etc... I should note that many PM vendors often uses transactions fees to offset capital costs of their R and D costs and ultimately make their software more affordable to the lowest common denominator, the small doc, who benefits greatly from having this capability.
What is that worth to you? Is x cents per transactions worth it? I can't answer that question but for some it is, for some its not.
Given these profound market forces as described above, I content the silence is deafening both from payors and providers and that silence is the secret you hear. If customers were screaming for this capability, I would have it on the market tomorrow. In fact, I can today...but again, no one is asking for it because no one at the small mid size provider level (our target market) has the resources to use and maintain it. They want to practice medicine and get paid what they are owed quickly.
I offer that you it is an illusion that HIPAA locked you into a vendor clearinghouse relationship. Nonsense. There are software companies out there that will allow you to output and input a native X12N. The way I see it, there is nothing stopping you except cost, complexity and efficiency.
Chris Brancato
[Yes, admittedly a PM vendor and a clearinghouse and a billing company.]
Director, Client Development
Chief Compliance Officer
Health Data Services
Charlottesville, Virginia.
-----Original Message-----
From: Fox, Harry [mailto:[EMAIL PROTECTED]]
Sent: Tuesday, June 03, 2003 1:33 PM
To: WEDI SNIP Transactions Workgroup ListWith all the talk about EDI I am continuously surprised that no one talks
about what I think of as one of the open secrets of HIPAA TCS--Most
providers, through their practice management systems are not submitting EDI
at all, but rather, using a variety of 'HIPAA Compliant' flat file or legacy
upgraded formats to clearinghouses who are converting these flat files, (and
in some cases adding or correcting data content for compliance), into an EDI
837. Many of these flat file formats are proprietary to a clearinghouse
further locking a vendor into a specific clearinghouse. Rather than
disintermediate the clearinghouses, HIPAA has locked us further into working
with clearinghouses indefinitely since most PMS vendors, particularly for
professional claims, have not added EDI to their systems. So when someone
writes about "the wisdom of using EDI", most of the PMS vendors I have
talked to have upgraded their systems for HIPAA required content, but EDI is
not in their plans.
Thanks,
Harry Fox
-----------------------------------------------------
Harry D. Fox
Vice President, e-Commerce
Coventry Health Care
6705 Rockledge Drive, Suite 900
Bethesda , MD 20817
Work: 301-581-5797
Fax: 301-493-0720
Coventry Health Care has a new look on the internet!
Visit http://www.coventryhealth.com <http://www.coventryhealth.com/>
[snip]
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