Kepa, Has there been any discussion of the mechanism (and where its funding might come from) by which providers' software vendors can be EDUCATED regarding this critically important issue? I have not met a single Office Management System vendor yet who understands that even if the X12 EDI messages are not going to be flying right out of the doctor's software, the required data elements for populating an 837 DO have to be in there and WILL have to be packaged up and handed off at some point to a "translator engine/entity" for conversion to the standard. I doubt that more than 5% of the OMS vendor community gets it that NONE of the old claim standards map reliably and consistently to the new HIPAA standards, and that sending NSF and "1500 print images" to a clearinghouse is NOT going to be much help to the doctor. Unless CHs and payors are prepared to massively "relax" these standards for awhile, we will be looking at a 90% reject rate for claims from small providers. This global misunderstanding (they don't even know that they don't know) may explain why almost no software vendors or doctors are coming to X12 meetings or asking questions about this... only a year before they are supposed to be in "testing mode".
(And if you think the OMS community is out of the loop on TCS standards, try asking a few doctors what they know about this! I'm doing a primarily TCS-related HIPAA presentation to 50 or 60 eye doctors in N. Calif. next week and they are pretty excited about hearing this. To date, all doctors have heard/read about HIPAA is the Privacy Rule. They just assume that their OMS vendors are wiring the TCS stuff into their next system upgrade.) Regards, Chris At 09:56 PM 4/8/02 -0600, Kepa Zubeldia wrote: >George, > >That is a very interesting point. Is your assumption that the clearinghouse >creates the transactions and has control of the code sets? The fact that the >clearinghouse has demonstrated the "capability" to use a certain code set >does not necessarily mean that each one of the providers clients of that >clearinghouse is using that same code set. I wish life was that easy. > >One of the typical "HIPAA Myths" is that the clearinghouses can magically >make the providers compliant. That is not the case. Let's make sure that >all the players understand what is their own responsibility. If the >expectations from providers are that their vendor or clearinghouse will take >care of HIPAA much like they took care of Y2K, we will run into big problems >when they wake up to the reality. > >Kepa > > > > >On Monday 08 April 2002 02:58 pm, George Kaye wrote: > > If a payer performs compliance testing with a clearinghouse for code set > > effectivity for a professional claim (for example), has anyone thought > > through the process of what that testing should consist of, so that the > > payer can assume that those code sets will continue to be compliant from > > that clearinghouse on an ongoing basis regardless of: the type of > > professional claim (office visit, ambulance, physical therapy etc.), or > > when the code is impacted by new code set releases by the DSMO's? > >To be removed from this list, go to: >http://snip.wedi.org/unsubscribe.cfm?list=business >and enter your email address. > >The WEDI SNIP listserv to which you are subscribed is not moderated. The >discussions on this listserv therefore represent the views of the >individual participants, and do not necessarily represent the views of the >WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official >opinion, post your question to the WEDI SNIP Issues Database at >http://snip.wedi.org/tracking/. >Posting of advertisements or other commercial use of this listserv is >specifically prohibited. Christopher J. Feahr, OD http://visiondatastandard.org [EMAIL PROTECTED] Cell/Pager: 707-529-2268 To be removed from this list, go to: http://snip.wedi.org/unsubscribe.cfm?list=business and enter your email address. The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. Posting of advertisements or other commercial use of this listserv is specifically prohibited.
