Jonathan, you say I'm clearly missing the boat, but I think
we are on the same page here. What I was saying is that
this new regulation enables the status quo, which I have
have been fighting for years. It allows everyone to
continue doing what they are doing, so what is the point?
Our software has been very XML-like for 10 years. We
accept XML into our system, and we do not currently accept
X12, so we have a vested interest, but not in the direction
you accuse. My company has been dedicated to reducing the
cost of claims administration, and we have made major
inroads at many payer organizations. We can process a
paper claim cheaper than an EDI claim, so we are currently
working on ways to reduce the cost of EDI as well, thus my
interest in EDI/XML standards. We built a DTD for the
HCFA-1500 and UB-92 and worked out a prototype with
zirmed.com to accept claims directly from them at our
customers through XML as a means of circumventing the
clearinghouse costs - the real culprit for costs in my
mind. This HIPAA legislation just prevented us from doing
anything with it. Back to the clearinghouse. So much for
XML.
I thought I expressed my dissapointment in this
legislation, but evidently it was miscontrued. My point (I
thought) was that the legislation was not going to do
anything to help to standardize transactions. I see it as
the "clearinghouse revenue enhancement act of 2000".
We are not a clearinghouse (although this legislation will
probably make us one). We are cutting claims
administration dramatically at our customers, so please
don't accuse me of being the 30% administrative cost when
you obviously don't know what we do. What I asked you was
how does HIPAA enable XML when it doesn't even enable X12.
I got an answer that said healthcare administration is
expensive, and XML will solve that, but I just am not
seeing the same view amongst my customers. XML has *no*
value to them. They are not allowed to use it to commun
icate directly between their trading partners according to
this legislation. Period. They do not have to use X12
either. Period. They are allowed to continue what they
are doing.
They have to use a clearinghouse, because there is no way,
XML or otherwise, that they can connect to the hundreds of
thousands of providers out there without them. In my
reading of the HIPAA legislation, there is no incentive or
reason for them to change what they are doing today.
Cheers
Chris Thompson
>
> Since the US spends 1.1 $Trillion/year on health care and
> about 30-40% is
> estimated to be releated to overhead (that's you BTW),
> that's about $300-400
> Billion/year in waste.
>
> That is all of our tax dollars at work, so I suppose we
> all ought to care.
>
> Clearly you are missing the boat. The problem is all the
> 'legacy' systems
> which don't work. Sure screen scraping is electronic, but
> that's not the
> point. Many providers spend alot of money getting the
> 'transactions' from
> paper (that's where 90% start) into an 'electronic'
format
> in the first
> place. Have you ever seen a medical chart? Where do you
> think the bills
> arise? How do you think those paper charts get converted
> into 'electronic'
> transactions? Magic?
>
> Most small physician's offices are charged an average of
> 10% off the top by
> medical billing services. Suppose we were able to take
> that money and apply
> it toward insuring all Americans. The point about XML is
> that it enables
> small as well as large providers to get into the EDI
> business without
> spending an arm and a leg.
>
> >
> > We process and send some 200 million health insurance
> > transactions a year, so this is not a trivial issue for
> > us.
>
> I'm sure you have a vested interest in keeping the status
> quo! Ought the
> government keep spending our precious tax dollars this
> terribly broken
> system? What XML enables is an electronic medical record
> system which can
> seemlessly link to legacy X12 EDI systems. Furthermore,
> HCFA will accept
> X12, not only from clearinghouses but directly from
> providers, so when
> providers can get EDI enabled they can afford to spend
> that extra 10% of
> their time on patient care and not on billing overhead.
>
> ... Can anyone
> > show me one single example where a covered entity has
to
> > do
> > anything different than it is doing today?
> >
>
> It remains to be seen how much impact Kennedy-Kastelbaum
> alone will have,
> but consider this: the U.K. spends about 5-6% of its GNP
> on healthcare and
> we spend about 12% (roughly). Our medical care certainly
> isn't twice as
> good. Ditto Canada. This is one benefit of a uniform
> payment system. Uniform
> transactions are merely a step along the path.
>
> </rant>
>
> Jonathan Borden
> The Open Healthcare Group
> http://www.openhealth.org
------ XML/edi Group Discussion List ------
Homepage = http://www.XMLedi-Group.org
Unsubscribe = send email to: [EMAIL PROTECTED]
Leave the subject and body of the message blank
Questions/requests: [EMAIL PROTECTED]
To receive only one message per day (digest format)
send the following message to [EMAIL PROTECTED],
(leave the subject line blank)
digest xmledi-group your-email-address
To join the XML/edi Group complete the form located at:
http://www.xmledi-group.org/xmledigroup/mail1.htm
