This from snip white pages:
MYTH #3: "Many providers are already HIPAA compliant with these transactions; what’s
the big deal?"
REALITY:
The technical nature of this issue has led some providers to believe that they arealready performing HIPAA standard transactions. However, they are almost always
using only one or two of the many HIPAA standard transactions and are nearly
always using earlier versions of these transactions, not the HIPAA-mandated
versions.
These providers are often unaware of the significant differences between general
ASC X12N transactions and the more detailed requirements of HIPAA standards
for each transaction, as articulated in the specific HIPAA implementation guides.
Further, many providers incorrectly believe that their clearinghouse or system
vendor already has this capability and is already converting to HIPAA standard
transactions. This is generally not true. Further yet, most providers have overlooked
the critical need for testing. Providers need to conduct testing with each payer for
a variety of transactions, not only for the format and content that is specifically
required, but also for any optional data elements that may be agreed to
contractually. In addition, many provider systems currently contain logic to create
payer-specific coding to accommodate payer- or plan-specific code sets. With the
elimination of non-standard codes, providers must "unwind" payer-specific
coding issues and implement new process to track and submit non-standard yet
required data. We are particularly concerned that few providers have assessed the
effect this code set conversion will have on their specific reimbursement levels.
Can anyone help me define the "unwinding" of the payer specific coding issues.
I must have much too simplistic of a view here....as these myths suggest. How is reimbursement affected when the code sets will be standard? We have not invested time yet in exploring the detail level of the 837s. Our vendor is assuring us of the ability to produce the 837s and will train us in building the claim checks necessary to handle the situational elements etc. By the same token our clearinghouse is ready to test ( waiting on intermediary ) and has given us similar assurances.
I simply do not see how our reimbursement will be impacted except in a very positive way.
thanks,
