Government Standards for Health Care Data Released

FRAMINGHAM (08/21/2000) - Though the health care industry is often wary of federal intervention, one piece of recent legislation may actually make the industry more efficient, according to information technology leaders and analysts.

Last week, the U.S. Department of Health and Human Services (HHS) unveiled standard formats for processing claims, authorizing referrals and handling other administrative tasks conducted electronically. The rules are part of the Health Insurance Portability and Accountability Act (HIPAA), passed by Congress in 1996. The HHS, however, is only now releasing guidelines for how to implement many of the new regulations.

Health care organizations must adopt the standards within 26 months or pay up to $100 per violation but no more than $25,000 per year.

According to the HHS, insurers currently use as many as 400 different electronic forms. But using a standard format should ease electronic communications between payers and health care providers by making transactions faster and less confusing, according to Richard Telesca, an analyst at Cambridge, Mass.-based Giga Information Group Inc.

"Cooperation is the issue with payers. They do everything they can to avoid paying claims," said Scott Novogoratz, vice president of information systems at Advanced Healthcare, a 250-physician group based in Milwaukee. "There's a real impetus now for health care organizations to work together to trade patient information."

Impending Costs

The new HIPAA rules will require IT workers at Advanced Healthcare to standardize the organization's electronic interfaces with payers, though Novogoratz is still assessing how much time and money that will take.

Because the new HIPAA rules employ ANSI X12, the standard used for electronic data interchange transactions, which are common in health care, most health care organizations shouldn't have a problem complying with this part of the regulation, unless they haven't upgraded their systems, added Novogoratz.

But other impending HIPPA changes promise to make the overall conversion as complex and expensive as year 2000 remediations were, although some predictions estimate that the cost will be triple that of Y2k, according to Cathy Eddy, chairwoman of the HIPAA working group at Irving, Texas-based VHA Inc., an alliance of approximately 2,000 community health care organizations.

In the coming months, the HHS will outline its rules for privacy and security and determine a code set to identify health care providers. The HHS has unveiled only about 10% of its entire HIPAA rules to date, said Mark Anderson, a vice president at Stamford, Conn.-based Meta Group Inc. and a former hospital CIO.

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