Act now to protect your practice
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Most practices are behind in
the HIPAA transactions and code sets testing effort. Most vendors,
clearinghouses and health plans are also behind. But there are steps you can
take right now to prevent disruption of claims payments in October, said David
C. Kibbe, M.D., AAFP's director of health information technology. Here are four
steps to get you started. The online story has the complete list of actions to
take to protect the financial security of your practice.
- Talk to your practice management system or billing system vendor
to determine your practice's readiness to send HIPAA-compliant claims to
payers, including Medicare, Medicaid and other commercial health plans.
- Reject such vendor statements as "Don't worry, we're HIPAA
compliant" in response to your queries.
- Request that your vendor immediately engage in end-to-end testing
(from your office all the way to the health plan's computer system) of these
new HIPAA-standard transactions with each payer or health plan.
- Plan now for disruptions in cash flow next fall by anticipating a
10 percent to 20 percent increase in rejected or delayed claims during the
fourth quarter of 2003. Put aside additional savings and cash reserves, put off
new expenditures during this period, and be prepared to get a commercial loan
if necessary.
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- Consult the practice management system directory for HIPAA
electronic data interchange at http://www.hipaa.org/pmsdirectory
for contact information for your vendor. Look for information there about the
readiness of your practice management and billing system vendor to conduct
business using the new HIPAA-standard transactions.
- List each payer or health plan to which you will send electronic
claims. This is important because each plan may implement the new standards in
a slightly different manner, so "generic testing" of the transactions at the
vendor or clearinghouse level is not enough.
- Know your HIPAA rights. If your practice has done its part to
assure that the claim information is formatted according to the new HIPAA
standards, the health plans cannot not reject or delay your claim on the basis
of format or content errors. If such a claim is rejected, file a complaint with
HHS at
https://www.cms.hhs.gov/hipaa/hipaa2/support/correspondence/complaint/default.asp?=Use+Secure+Server.
- Download "HIPAA Transactions and Code Sets Standards: A How-to
Guide for Your Medical Practice" at http://www.aafp.org/x3095.xml. The
Academy has provided other tools at the site as well, including a list of
questions you should ask your vendors.
- Locate another practice management system vendor if you're
uncomfortable with your vendor's answers or testing commitment.
FP Report is published by the
AAFP News Department.
Copyright © 2003 by
American Academy of Family Physicians.
