Rewrite the HIPAA Transactions?
HDM Breaking News, October 29, 2009
The consolidated health care reform bill that House Democrats introduced on Oct. 29 includes provisions to strengthen and make uniform the HIPAA transaction standards.
The 1,990-page bill, H.R. 3962, also would require the Food and Drug Administration to implement a unique medical device identification system, called UDI, within six months of enactment. Premier Inc., a provider alliance, hailed the UDI provision in a statement. "The distressing reality is that we can identify and remove tainted peanut butter and dog food from the market before reaching consumers, but in healthcare, patients risk having a recalled medical device used in their treatment because there is no way to quickly and reliably locate a recalled device."
The consolidated House reform bill would fundamentally rewrite existing HIPAA transactions rules by making national standards for electronic claims and related transactions far more uniform than they are today. Many of the reform bills have advocated adoption of "operating rules" that payer advocacy organization CAQH has developed to standardize the HIPAA transaction standards.
Under Sec. 1173A of the new House bill, transactions would "be authoritative, permitting no additions or constraints for electronic transactions, including companion guides," the legislation states. Transactions would be developed to enable determination of an individual's financial responsibility at the point of service--or even before. They would support machine-readable identification cards and "enable, where feasible, near real-time adjudication of claims." The transactions also would harmonize all common data elements across administrative and clinical transactions.
The legislation calls for implementation and enforcement of the tighter transaction sets within five years of enactment. It also calls for the Department of Health and Human Services to issue interim guides, including operating rules. "The Secretary shall adopt a single, binding, comprehensive companion guide that includes operating rules for each X12 Version 5010 transaction described in section 1173(a)(2), to be effective until the new version of these transactions which comply with section 1173A are adopted and implemented." The legislation would require HHS to consult with an unnamed but specific organization; the definition of the organization matches CAQH.
HB 3962 is available at http://waysandmeans.house.gov/.
--Joseph Goedert
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