Healthcare Reform through HIPAA Simplification

Everyone knows that healthcare reform is the hot topic in Washington DC and that representatives and senators are hearing from many constituencies.

The HBMA (Healthcare Billing and Management Association) is the professional association of leading medical billing companies, including AHS. HBMA has done an excellent job highlighting practical areas to reduce costs and streamline today’s overly complex billing procedures. The key message is that “administrative simplification”, as called for in the original HIPAA regulations, can save billions and billions of dollars.

There are four specific areas where Congress can make a real difference by simply requiring CMS and insurance companies to fully implement existing HIPAA regulations:

• Outlaw companion guides

• Give CMS/HHS true enforcement authority

• Direct CMS to issue final standards for electronic claims attachments

• Mandate use of key fields in ERAs

At this point, we encourage you to contact your local congressman or woman and your Senators (see below if you don’t have their contact information) to emphasize these points. As an expert in the physician reimbursement process, your views will be particularly influential. A draft letter is provided below that you can personalize and send. The HBMA document referred to is available at the "HIPAA Simplification" button below. Written letters with personal signatures have the most impact. It would be even better if you were to contact their local offices during a recess and deliver your letter in person.

The good news is that our message has clear benefits for each of us as citizens and taxpayers. While these reforms would be beneficial for AHS and other billing companies, the primary benefits would flow to physicians and to each of us who pays for healthcare.

Thank you for helping the cause.

AdvantEdge Healthcare Solutions

reform@ahsrcm.com

Draft Letter

See below for the correct format, e.g.

 The Honorable (full name)
(Room Number) (Name) Senate Office Building
United States Senate
Washington, D.C. 20510

Dear Senator (last name):

As a person who works every day to help physicians collect what they are owed from insurance companies, I routinely see wasted time and money that would be much better spent on improved patient care.  I can’t fix these issues but I am hoping that can.

When an electronic claim is sent to an insurance company today, I can’t just use the standards set by HHS; instead I have to refer to the “companion guide” from each insurer. This doesn’t make sense since the information is the same. Why does each company get to write its own rules? To make matters worse, I’m told that CMS can’t really penalize companies that don’t follow the standards.

Adding unnecessary time and cost, there are no standards or instructions about how to send an electronic attachment. In today’s electronic world, this makes no sense. If an insurer wants a copy of an X-ray today, we have to send a hard copy! CMS (or someone) should make the rules and enforce them.

A final example: when an insurance company sends an ERA (electronic remittance advice), they don’t use many of the fields, and each insurer seems to approach them differently. This means a lot of manual work that shouldn’t be needed at all.

The professional organization called HBMA has focused on these issues. I strongly recommend you read their recommendations, which I’ve attached. But mainly, I hope that you can apply some common sense to situations where it is sorely lacking today.

Respectfully,

Members of Congress can be reached via their Websites – www.house.gov and www.senate.gov.  If you do not know your Congressional district, use http://www.house.gov/zip/ZIP2Rep.html.  The Members’ site will list their Washington, DC and local offices along with addresses and phone numbers. 

Here is the proper way to address the letter when writing to Washington DC; substitute the local address when sending to it.

It can’t hurt to send to both offices.

For Your Senator:

The Honorable (full name)
(Room Number) (Name) Senate Office Building
United States Senate
Washington, D.C. 20510

Dear Senator (last name):

For Your House Representative:

The Honorable (full name)
(Room Number) (Name) House Office Building
United States House of Representatives
Washington, D.C. 20515

Dear Representative (last name):