Headline news in health care is usually about cost.  Now, we expect that by 2013 the entire industry will be required to provide quicker answers with less paperwork.   New rules that will help determine whether a patient can receive services from a health care provider according to their health plan, and the status of associated claims for those services are expected by 2013 if a new rule is finalized.

Last year we published a whitepaper noting that we expected gradual adoption of CAQH CORE rules with higher standards for determining patient eligibility and claim status via electronic systems.  In fact, complete eligibility information at the point of care, we predicted, would not be far off.

Headline news in the health care industry is finally arriving. July 30, 2011 the U.S. Department of Health and Human Services (HHS) published an interim final rule, which adopts operating principles developed by the Council for Affordable and Quality Healthcare’s Committee on Operating Rules for Information Exchange (CAQH CORE).

This is a first step toward implementation of an Affordable Care Act provision that cuts red tape in the health care system.   HHS estimates this will save $12 billion over ten years.

  • Whether a patient is eligible for coverage
  • The status of a health care claim submitted to a health insurer

The interim final rule issued requires compliance by health plans, health care clearinghouses, and certain health care providers by January 1, 2013.

The rule is the first of many that are expected, focused improvements to the health care system. Future rules, which will likely make headline news in healthcare, will address adoption of:

  • Electronic funds transfer and remittance advice;
  • A unique identifier for health plans;
  • A standard for health care claims attachments; and
  • Requirements that health plans certify compliance with all HIPAA standards and operating rules

The Office of the Federal Register posts rules for public inspection at this link: http://www.ofr.gov/inspection.aspx#special. The rule is set for publication on July 8, 2011. Comments will be accepted if submitted by 5:00 p.m. EDT September 6, 2011.

Expect revisions and extensions to HIPAA 5010, the new EDI standard to deal with this in the future.  Also, as ICD-10 CM becomes updated starting in 2014 there may be updates to diagnosis and procedure codes that support greater efficiencies.

Related Posts
(Visited 18 times, 1 visits today)