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HIPAA TCS Status Summary of Compliance per CMS
012704 HIPAA TCS Status Transcript of Dec 10 2003 Meeting
DEPARTMENT OF HEALTH AND HUMAN SERVICES
NATIONAL COMMITTEE ON VITAL AND HEALTH STATISTICSMeeting of:
The Subcommittee on Standards and Security
December 10, 2003
Agenda Item: HIPAA Update - Ms. Trudel
MS. TRUDEL: Well, I'll be brief, perhaps that will set the tone, too.
I'm going to talk about three things, one is the status of regulations, another is just shortly an overview of what I'm personally hearing about industry readiness, and then third a little bit about enforcement and the enforcement process, complaint that we're getting to date, etc.
With respect to the regulations we are still on target to publish the National Provider ID Final Rule on December 20, well, now, it won't be December 26th because the federal government will be closed, in any case, late December is the publication for the National Provider Identifier Final Rule. We are beginning the review process on the claims attachment proposed rule with the CDA approach that Sue and Wes will be talking about a little later. And the plan identifier also continues to be in the review process.
We are beginning to establish a strategy on proposed rule for ICD-10 with special attention going to the notion of the impact analysis to make sure that we can use the information that we got from the RAND study, augment that with other information and really come up with something that will be very solid, that the industry will be able to comment on hopefully very concretely.
We're also working on the next modifications regulation, which will include as far as I know some updates that have to do with responses to the Secretary's Committee on Regulatory Reform, some suggestions were made there for improving definitions and clarifying some information about direct data entry, etc., so we're working on that as well.
Moving on to readiness, the latest Medicare statistics that I've seen show that the percentage of HIPAA compliant claims in production is now around 50 percent, the carriers, the fiscal intermediaries are working very intensively with providers and clearinghouses to get their testing done. We continue to see an upward trend and there are a number of problems as you would imagine with something this complex. We've been meeting periodically with representatives of various health plans and it appears that we're all hearing the same kinds of things, so this is just a complicated process that we need to work our way through, and of course the contingency gives us an opportunity to do that without harming cash flow or operations.
Moving on to enforcement, we have received just a handful of complaints, I think at the last time I checked it was maybe about ten that were valid complaints that had to do with transactions and code sets, and our staff is working through that process, getting back to the people who filed the complaints, back to the people against whom the complaints were filed, trying to work through either coming up with corrective action plans or providing technical assistance to the covered entities, so that process is ongoing and at this point the workload is quite manageable.
I think that's about all I have to report, I'll be glad to take questions.
DR. COHN: I think Mike and then Jeff.
DR. FITZMAURICE: Karen, I think you mentioned that you've met with health plans and have heard all kinds of things. Were the kinds of things you heard the same areas of difficulty that the Medicare program as a health plan itself is facing and what were some of those kinds of things?
MS. TRUDEL: It's just a matter of working through problems one by one, it seems that various submitters are having, I mean the problems are just all over the board, you can't say it's just ten data elements or it's one thing, it seems to be just a complete mixed bag and that's what we're seeing, too.
DR. FITZMAURICE: Can you say that it's more professional providers, that is physicians rather then hospitals? Can you say that it's more vendor issues and not having the right software rather then inability for clearinghouses to get the formats right?
MS. TRUDEL: I would hesitate to make any kind of generalizations at all.
DR. FITZMAURICE: Is there somebody from the Medicare program who could talk about the issues from the standpoint of the Medicare health plan as compared with other health plans?
MS. TRUDEL: Yeah, we could certainly get someone from the Office of Information Services to come and do that at the next meeting if you'd like.
DR. FITZMAURICE: A second question, that is HIPAA was put out to improve efficiency through the use of electronic transactions, and a lot of people in the industry have told me that they would like to see an internet policy come out that would allow them to submit claims using the internet, feeling that that would be one of the most cost efficient methods they could have for transmitting claims. For the past year or more that issue has surfaced and is there a plan policy that would permit contractors and the people who send their claims into the Medicare contractors to use the internet for such purposes and what is the biggest obstacle for that?
MS. TRUDEL: Again, I'm sorry Mike, I can't really answer that, that's in the purview of our chief information officer and I'm not familiar with what's going on in that area right now. And again, we can arrange to have someone come and present to that if that's something that the subcommittee is interested in.
DR. FITZMAURICE: Thank you, Karen.
DR. COHN: Jeff?
MR. BLAIR: Karen, I read something in the Trade Press and it indicated that there was a percentage figure for compliance of, in other words the number of claims that are received that comply with the HIPAA financial transactions that HHS has, and I don't want to quote what that percentage is, I just want to ask you is there a threshold that has been set forth and when we reach that threshold that is when HHS will then wind up saying okay, we'll give the industry a certain amount of more time? Or is that still being something where you're seeing how things go and leaving all options open?
MS. TRUDEL: I guess the easy answer is we haven't set a specific percentage like we get up to 85 percent, that triggers all these different actions. What we're really looking at is how our progress is going and what the curve looks like, so I think that's really probably the more important way to look at it. And the other thing I want to stress is that we won't be pulling the plug on the overnight anyway, we will make sure that we give providers and submitters ample notice that as of a certain date the contingency would be lifted.
MR. BLAIR: Thank you.
DR. COHN: Stan and then Kepa.
DR. HUFF: A quick question. I've been recommending the RAND study as reading for friends and relatives, but I had a hard time finding an electronic copy on the web. Has it been posted somewhere? Where is that?
MS. TRUDEL: Yeah.
MS. GREENBERG: It certainly will be posted on the web. In order to, as I think I mentioned at a previous meeting, we need to bring the contractual relationship to RAND to a close because we had extended the work and extended the time period, and so we are waiting for the final electronic version. There's paperwork going back and forth, so until that's concluded we're not going to have the final electronic version to post on the web and I expect it very, very soon but we just don't have the final version at this point.
DR. COHN: So in other words you're seeking a version that doesn't have draft in light print across every page and things like this.
MS. GREENBERG: Well, if we don't get this, it's not RAND's fault, I mean it's a question of just getting the paperwork through both the government and RAND but we should have it very soon.
DR. COHN: Mike on this point or a different point?
DR. FITZMAURICE: It's a follow-up to what Stan asked.
DR. COHN: Okay.
DR. FITZMAURICE: In the last meeting of the full meeting of NCVHS the NCVHS approved the ASCA report and I had the same experience trying to refer someone to the NCVHS website for it. Did I miss it or is it not there yet?
MS. GREENBERG: I can't check the website at this moment but I will, you provided it to, we'll make sure that it gets posted, it should be posted and in fact we have the annual HIPAA report references that it's posted. So there shouldn't be anything delaying that, I apologize --
DR. COHN: Kepa?
DR. ZUBELDIA: Thank you. First I would like to everybody to speak directly and very close to the microphone, it's very, very hard to hear. And because of that I missed Karen's number, whether you are at 50 or 60 percent.
MS. TRUDEL: It's at about 50 right now Kepa.
DR. ZUBELDIA: Karen, are you also tracking the number of submitters and the number of providers that are sending electronic claims or CMS is only tracking the number of claims?
MS. TRUDEL: We're tracking the number of claims and the number of submitters, not the number of providers.
DR. ZUBELDIA: Do you know approximately what percentage of submitters are sending the HIPAA transactions?
MS. TRUDEL: Not off the top of my head but we get a weekly report on that, we are looking at it.
DR. ZUBELDIA: And how about the other transactions, how is that going?
MS. TRUDEL: Those are somewhat lower, we're especially having issues with the coordination and benefits transaction, there is a need to coordinate and make sure that both the sender and the receiver understand exactly what is in the transaction, what kinds of editing is being done, there are problems with gap filling when we get a transaction that's not HIPAA and we cross it over, there's a need to fill some gaps in order to make a compliant transaction, and the rules for that are causing some consternation but we're working that through basically trading partner by trading partner and I understand that we're making some really good progress there.
DR. ZUBELDIA: Thank you.
DR. COHN: Michael?
DR. FITZMAURICE: Are there any coordination of benefit claims coming through electronically and is there difficulty with those in particular compared with the other transactions?
MS. TRUDEL: From Medicare perspective the coordination of benefit transactions, are you talking about MSP claims? Medicare's Secondary Payer?
DR. FITZMAURICE: That's part of it, yes, the other part is Medicare Primary Payer and then going to other insurance companies.
MS. TRUDEL: Right, the crossing over at the back end is what's the problem is and it's just making sure that everyone understands what rules we followed to build what we thought was a compliant transaction. But yeah, we are sending crossover files in production.
DR. COHN: Helene, please introduce yourself.
MS. GUILFOY: Karen, are those rules of what you're requiring to be sent forward in COB published somewhere? Because the only thing that the providers have had to work with is an IG, which is different then what the Medicare contractors are requiring. In other words the Medicare contractors are not requiring a fully formatted fully data content claim as the primary claim going to Medicare, yet the payers on the COB side are yet requiring that. So if a provider submits a fully compliant fully content rich claim to Medicare then it can be sent forward but if a provider is submitting what the Medicare contractors are requesting then you don't have the information to submit a compliant claim forward to the secondary payer.
MS. TRUDEL: We are building compliant claims for crossover, even when they come in on paper.
MS. GUILFOY: I'm not talking about paper, I'm talking about electronics.
MS. TRUDEL: Or electronic in old formats, it doesn't matter, we're gap filling or expanding, we're doing whatever we need to do to build a compliant crossover claim even though the incoming claim from the provider was not. So there aren't any requirements on the provider in this matter, this is something that --
MS. GUILFOY: I guess my question is how can you back fill when the information is just not available in the electronic format. We can talk about this later but --
MS. TRUDEL: I think it's also an issue that's outside of my purview and more in the purview of the EDI folks at CMS.
MS. GUILFOY: So is there somebody that --
MS. TRUDEL: Yeah, I'll give you a contact.
MS. GUILFOY: Super. Thank you.
DR. COHN: We may have to schedule a session with the CIO or his representative to talk about some of these issues.
Other questions before we move on? Karen, thank you very much, and I'm pleased that progress is being made and we're moving forward.
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