Chris,
Perhaps I have misconstrued your statements. The "who cares?" did irk me, I
thought you were saying "who cares about XML". Sorry.
> 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?
What I see is that it requires everyone to speak the same, well defined,
language. This is a step in the right direction. Now we can write a single
XML <-> X12 converter. Payors won't be able to say: "Sorry, we only accept
claims in xxxx proprietary format, see yyyy clearinghouse if you want to
speak to us."
We have developed a model, and software, which integrates many formats into
an XML/XPath/XSLT/DOM processing model. This model creates a "grove" or
abstract representation of various serialization formats e.g. XML, X12, HL7,
MIME even CSV etc. etc. etc. based upon an XML property set representing the
EBNF productions describing the particular grammar. see;
http://www.openhealth.org/XSet for an early technical description.
So for us, X12 EDI is yet another serialization format which can itself be
represented in XML. The logical data format is what is important. Even more
important are the semantics. As long as there is a single place where I can
go to and get a single spec which describes what bits go where, we are
happy.
> 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.
Suppose we were to supply an XML <-> EDI conversion process. You can accept
EDI and convert to XML for your customers, we accept XML (actually our
system creates the XML in the first place) and provides EDI as a gateway.
What is the problem?
>
> 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".
I don't necessarily agree. As I see it, the standard, backed by legislation,
requires all parties to speak the same language, That in and of itself is a
"good thing" regardless of which language we are all speaking. You bring up
the point that the "loopholes" exist. True,
>
> 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.
I don't really mean to accuse you directly, but in large part it is the
existence of paper in the system which creates the overhead. On the other
hand paper is needed because current software is too cumbersome for end
users to use --- how many M.D.s in the country do you think operate software
to submit electronic claims? (hint: very few). On the other hand how many
M.D.s assign their own CPT codes to procedures (hint: more and more). How
many M.D.s know the text name of the procedure -- that is can pick from a
list that corresponds to a CPT code (hint: hopefully even more).
So the scribbling down of a few words, or numbers on a paper form or slip of
paper, gets handed to an administrator who enters some information into a
screen, and this gets passed on to a billing person who pulls a chart and
correlates a few more fields and then this gets passed on ... and errors
accumulate and costs accumulate.
> 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.
well actually, they do need to accept X12, if I, for example, send it. If
they wish to pay a service ('clearinghouse') $$$ to convert from X12 into a
legacy format, that is *their* business. HCFA is the biggest payor, so as an
example, HCFA is required to accept X12. A payor which is not currently
accepting X12 must change its behavior (who it pays to accept X12 is not the
concern). A traditional clearinghouse translates the transaction into a
format specified by the payor and is paid by the provider (or agent
thereof).
Jonathan Borden
The Open Healthcare Group
http://www.openhealth.org
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