Reform Focus Shifts to the Senate
In a 220-215 vote, the U.S. House passed a massive health reform bill Nov. 7. The bill, like two pending proposals in the Senate, retains administrative simplification language to make more uniform the HIPAA transaction sets for claims and related transactions.
In a 220-215 vote, the U.S. House passed a massive health reform bill Nov. 7. The bill, like two pending proposals in the Senate, retains administrative simplification language to make more uniform the HIPAA transaction sets for claims and related transactions.
The Senate is expected to begin considering its health reform proposals later this month.
The House bill's language requires adoption of "operating rules" that payer advocacy organization CAQH has championed to standardize the HIPAA standards. The goal of the operating rules is to make financial and administrative transactions as easy to conduct as an ATM transaction.
Under language in the House bill, H.R. 3962, transactions "would be authoritative, permitting no additions or constraints for electronic transactions, including companion guides." Transactions would be developed to enable determination of an individual's financial responsibility at the point of service.
The House bill also would expand HIPAA transactions by mandating use of the claims attachment standard. Further, the House bill would require the Food and Drug Administration to implement a unique medical device identification system, called UDI.
Both the House and Senate bills would mandate use of machine-readable identification cards and a health plan identifier.
In statements supporting House passage of health reform, the American Medical Association and the Medical Group Management Association both noted the administrative simplification provisions in the bill. "These modifications will, quite literally, transform the health care delivery process," MGMA said.
The AMA and MGMA also called on the House to quickly pass H.R. 3961, which would eliminate the Sustainable Growth Rate Formula for determining Medicare physician payment rates. "In recent years, the formula has resulted in large, scheduled cuts in Medicare payments to physicians that Congress has reduced or eliminated. Absent any changes this year, Medicare payments to physicians will be cut by 21% in 2010.
--Joseph Goedert
The Senate is expected to begin considering its health reform proposals later this month.
The House bill's language requires adoption of "operating rules" that payer advocacy organization CAQH has championed to standardize the HIPAA standards. The goal of the operating rules is to make financial and administrative transactions as easy to conduct as an ATM transaction.
Under language in the House bill, H.R. 3962, transactions "would be authoritative, permitting no additions or constraints for electronic transactions, including companion guides." Transactions would be developed to enable determination of an individual's financial responsibility at the point of service.
The House bill also would expand HIPAA transactions by mandating use of the claims attachment standard. Further, the House bill would require the Food and Drug Administration to implement a unique medical device identification system, called UDI.
Both the House and Senate bills would mandate use of machine-readable identification cards and a health plan identifier.
In statements supporting House passage of health reform, the American Medical Association and the Medical Group Management Association both noted the administrative simplification provisions in the bill. "These modifications will, quite literally, transform the health care delivery process," MGMA said.
The AMA and MGMA also called on the House to quickly pass H.R. 3961, which would eliminate the Sustainable Growth Rate Formula for determining Medicare physician payment rates. "In recent years, the formula has resulted in large, scheduled cuts in Medicare payments to physicians that Congress has reduced or eliminated. Absent any changes this year, Medicare payments to physicians will be cut by 21% in 2010.
--Joseph Goedert
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