FREE Health Data Management Site Registration

Sign up today and access the leading source of Health Care I.T. information on the Web.
Your FREE site registration entitles you to:

Free Health Data Management e-newsletter
 
Search more than 12,000 articles
 
Access Web Seminars on a host of I.T. topics
 
White Papers and Industry Research that provide valuable insights on a variety of technologies and implementation issues
 
Podcasts, updates on industry events, and much more!

 
   

Practices Go Beyond Basics With EDI


By Greg Gillespie, Editorial Director January 2007
The Health Insurance Portability and Accountability Act has gone a long way toward sorting out the mess surrounding the electronic submission of health care claims.

HIPAA's transactions and code sets rule delivered a standard framework to transmit and receive claims and many related transactions. Provider organizations still complain about payers requiring optional data in their claims forms, but electronic data interchange between providers, clearinghouses and payers is much cleaner than it was before the standard transactions went into effect, experts say.

But now that the industry has the claims side of the house in order, numerous efforts are under way to use EDI to streamline the flow of clinical and financial data among various health care stakeholders that need to touch the information to perform transactions.

"At this point the industry has a pretty mature backbone for administrative transactions, and it's now time to start looking at what can be done on the clinical side," says Art Glasgow, director of product development at Richmond, Va.-based Payerpath, a claims clearinghouse owned by Raleigh, N.C.-based Misys Healthcare Systems.

But the expansion of EDI into other transaction realms isn't going to happen overnight, Glasgow says. "We're still using a legacy format in the claims processing world, and that's good and bad-good that we have a degree of standardization, bad in the sense that it limits what type of transactions can be performed. But the Internet and technologies like Extensible Markup Language are really opening up the world."

In the past few years, vendors of claims processing software and services have used the Internet to expand the capabilities of their offerings. Many practices are using the Internet to transmit claims as well electronically process related transactions such as remittance advice.

At the Cardiology Center of Amarillo, Texas, Internet-based claims management has helped streamline numerous administrative functions, says Sharon Secrist, accounts receivable manager.

The practice uses an Internet portal from St. Louis-based Gateway EDI to submit claims, check patient eligibility and check claims status. It also set up electronic funds transfers from the majority of payers with which it does business. These payers send payments directly to the practice's bank account, and electronic remittance is automatically posted in its practice management system.

"Processes that used to take me and the rest of the staff hours to do now can be done in a few minutes," she says.

The Cardiology Center of Amarillo also is starting to expand its EDI transactions, and its experience offers a microcosm of the challenges of using EDI beyond HIPAA transactions.

The practice's third-party billing service hosts a Web site that enables the cardiology center's patients to pay bills online using credit and debit cards. But the transaction is not yet automated, Secrist says.

If a patient uses a credit card, the card number and other information is sent from the billing service's Web site to Secrist via e-mail. From that point, she has to log onto the Gateway EDI Web site and type in the credit card information. The portal sends back an authorization number for the transaction, which then has to be logged back into the practice management system.

EMR in the driver's seat

EDI transactions beyond the HIPAA claims transactions are proving to be a challenge for group practices. Many vendors are focusing their efforts to use EDI for clinical transactions in the electronic medical record. They share the belief that EMRs, when widely adopted, will act as interconnected data exchanges for physicians and their peers and business partners.

More Feature Articles

Hospitals Archive
Group Practices Archive
Payers Archive

I.T. Spotlights