Best Insurance Guide

This is going to be unpopular with some, applauded by others, but this is my truth; all this talk about HIPAA is nothing but a lot of hype. The federal government has once again come up with something that’s supposed to be a positive step towards helping patients with things such as privacy and understanding of hospital bills. There’s supposed to be administrative simplification of information both electronically and on paper, and a standardizing of codes for insurance and tracking purposes.

I’m not sure how many folks who receive this newsletter also participate on any listserves. If you do participate, you realize just how complicated this HIPAA thing has become, and if you’re like me, you don’t get it. The latest buzz is that as of October 16, which is today, ICD-9 procedure codes are no longer allowed to show on outpatient surgery claims. The problem with this directive is that not only do most hospitals not know about it, but many insurance carriers didn’t know about it either, including many Medicare intermediaries across the country. My own local carrier, for instance, had something posted on their page as recently as September 14th saying to make sure to select the most correct ICD-9 code when submitting claims to Medicare as of 10/1/03. There was no further mention of this other ICD-9 directive, even checking earlier today before completing this newsletter.

On this issue, what the heck does patient accounting have to do with it? We don’t code any of the claims; we don’t select the billing format; most of the time we don’t even see the bills because the claims are going out automatically. Also, HIPAA doesn’t cover everyone; it doesn’t cover compensation or no fault or Champus or self pay claims. Well, most self pay claims, depending on the type of paper format you use in sending claims to patients.

Next issue, privacy. I have to admit I was amazed to find out that every state didn’t already have rules for how to protect the confidentiality of their patients, but the overwhelming majority do. However, what happened to the simplification part of this HIPAA directive? Last year on the listserve I was reading where some facilities had created contracts upwards of 30 pages in trying to list every single issue they could think of where there might have been a breakdown of confidentiality. Some of them were looking to hand this literal tome to patients to have them read and sign off on; how did that become simple?

Once again, what did it have to do with patient accounting? Unless you were over registration, it didn’t change the bills; it didn’t change how your cash came in the door when you billed your insurance companies. It may have changed how you could talk to patients on the phone about their bills, or the bills of their family members, but when it did I doubt any member of patient accounting actually found that the process became simpler.

Next issue, electronic submission rules. The overwhelming majority of facilities were already submitting claims electronically. Suddenly, there IS departments had to work to change their formats from how claims had been going out previously, and in many instances they had to add encryption standards that they weren’t even sure they would be allowed to stick with, because the powers that be came up with this rule of encryption without thinking of setting a standard for the type of encryption that most facilities should try to reach. All of this on top of the fact that at least half of the hospitals throughout the country had gone through a computer conversion just prior to the millennium, and some others were already going through the motions of looking at new systems to replace those, and the process was now gummed up because one didn’t know how the new system providers would be able to accommodate whatever changes needed to be made as the HIPAA committee kept meeting and changing their minds.

There was one big brouhaha that occurred on one listserve because, at this one facility, the patient account manager didn’t know that the hospital had set up their encryption for incoming email to automatically create emails send back to the sender if a certain word was in the subject line. What occurred is, because it was a part of the listserve, their system sent out multiple emails to multiple participants, then kept replicating itself until someone finally contacted the person who had initiated the email from this facility to let them know what was going on (yours truly, I might add), as this person wasn’t receiving the emails because of the word she had put into the original email.

Of course one of the purposes for coming up with electronic submission rules was for the purpose of being able to send electronic medical records to payors instead of putting them in the mail when requested. The problem with that, as most of us know, is that most payors aren’t prepared to receive electronic medical records, and many facilities aren’t prepared to send electronic medical records.

The final part of the electronic standards was to allow physicians and hospitals to transfer information to each other electronically. This may work fine in large facilities, but how many smaller facilities have this as even a forethought, let alone can look to it as a reality? Yet, even those facilities have to change their billing and statistical standards to accommodate the possibility of this occurrence at some point in the future.

Simplification? How many meetings did you have to go to where, for most of it, you sat there trying to stay awake? How many questions did you have to try to respond to that didn’t seem to make any sense because they had nothing to do with what you did on a daily basis? How many projects were you put in charge of without really knowing what you were supposed to do, yet were expected to know more of than any of the other employees in your facility?

In the original HIPAA initiative, these were some of the positives outlined for the benefit of all:

There are more, but the point has been made, or at least begs the question; how many of these items has your facility or physician’s group actually attained since you began working towards these standards? I hope you’ve had better success than the norm, because this has been a costly venture to date, and one that’s going to remain costly in some way for at least the next few years.

By : Mitch Mitchell

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