There are so many regulations already out, and still in the pipeline, to implement aspects of the Affordable Care Act and the HITECH Act that it’s easy to forget or downplay the importance of some of the rules.

For instance, administrative simplification initiatives don’t get a lot of attention, but they should because there is a lot happening and it will affect providers’ revenue streams. The reform-mandated operating rules to tighten HIPAA transactions are becoming real. The compliance date for adoption of rules for the eligibility and claim status transactions was January 1, though the feds recently announced a 90-day grace period. There are plenty more operating rules coming in the next few years, not to mention the looming ICD-10 deadline and regular updates to existing HIPAA transactions.

At HIMSS13 in New Orleans, 30-year HHS veteran Stanley Nachimson, now principal at the Nachimson Advisors consultancy, will lay out what’s real now and what’s coming soon. For instance, federal contractor National Government Services is working with a dozen partners to develop testing methodologies for health plan/provider end-to-end testing of operating rules and ICD-10.

Further, an initiative of the Healthcare Information and Management Systems Society and the Workgroup for Electronic Data Interchange this March will start ICD-10 pilot testing with health plans, providers, clearinghouses and software vendors. The testing will start with basic use cases, such as taking a medical record description, doing some coding and putting the information in a claim that can be processed.

Nachimson will present schedules on various initiatives and ways to use the new standards to make the revenue cycle more efficient. He’ll also present recommendations that the National Committee on Vital and Health Statistics soon will issue on the upcoming claims attachments standards, giving an idea of what the standards could look like.

Too often, Nachimson says, stakeholders don’t get into the details of standards until they are published, when they need to understand how the standards are being developed so they can see how they can be beneficial and where improvements can be made. “There are quite a number of things going on that you need to be aware of.” Education session #113, “Administrative Simplification--There is Much More to Come,” is scheduled on March 6 at 8:30 a.m.


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