Department of Health and Human Services (HHS) Secretary Kathleen Sebelius today announced a proposed rule that would establish a unique health plan identifier under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The proposed rule would implement several administrative simplification provisions of the Affordable Care Act.

The proposed changes would save health care providers and health plans up to $4.6 billion over the next ten years, according to estimates released by the HHS today. The estimates were included in a proposed rule that cuts red tape and simplifies administrative processes for doctors, hospitals and health insurance plans.

“The new health care law is cutting red tape, making our health care system more efficient and saving money,” Secretary Sebelius said. “These important simplifications will mean doctors can spend less time filling out forms and more time seeing patients.”

Currently, when health plans and entities like third party administrators bill providers, they are identified using a wide range of different identifiers that do not have a standard length or format. As a result, health care providers run into a number of time-consuming problems, such as misrouting of transactions, rejection of transactions due to insurance identification errors, and difficulty determining patient eligibility.

The rule simplifies the administrative process for providers by proposing that health plans have a unique identifier of a standard length and format to facilitate routine use in computer systems.  This will allow provider offices to automate and simplify their processes, particularly when processing bills and other transactions.

The proposed rule also delays required compliance by one year– from Oct. 1, 2013, to Oct. 1, 2014– for new codes used to classify diseases and health problems. These codes, known as the International Classification of Diseases, 10th Edition diagnosis and procedure codes, or ICD-10, will include new procedures and diagnoses and improve the quality of information available for quality improvement and payment purposes.

Many provider groups have expressed serious concerns about their ability to meet the Oct. 1, 2013, compliance date. The proposed change in the compliance date for ICD-10 would give providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition to these new code sets.
The proposed rule announced today is the third in a series of administrative simplification rules in the new health care law. HHS released the first in July of 2011 and the second in January of 2012, and plans to announce more in the coming months.

More information on the proposed rule is available on fact sheets (4/9/12) athttp://www.cms.gov/apps/media/fact_sheets.asp.

The proposed rule may be viewed at www.ofr.gov/inspection.aspx. Comments are due 30 days after publication in the Federal Register.

HAS YOUR PRACTICE BEEN AFFECTED BY THE LACK OF MEDICARE AND COMMERCIAL INSURANCE PAYMENTS?

Like most practices and physicians throughout the country, you are not alone.  The root of the problem seems to be the result of the federally mandated transition to HIPAA Version 5010, enacted on January 1, 2012.  As a nation-wide medical billing company, we see all the medical insurance claims that get sent, rejected and processed to a large variety of insurance companies throughout the United States for our clients.  What we started to notice after HIPAA Version 5010 was enacted, was that Medicare, TRICARE, and a select few of local Blue insurance carriers have halted processing medical insurance claims.  When we first started noticing a lack of payment from these insurance carriers, we inquired with the insurance carriers as to where the money was; they returned with little, to no information as to if the claim was on file or not.  We then consulted our clearinghouses about the issue, who then told us the claims were  forwarded to the insurance companies.  Thousands of dollars in unpaid medical insurance claims are just floating in the clouds with little to no information as to why.

On Feburary 1, 2012, Susan Turney, MD, MS, FACP, FACMPE, Medical Group Management Association's president and CEO sent The Honorable Secertary Kathleen Sebelius of the Department of Health and Human Services a letter asking the government to take "immediate action to address the payment disruption issues that have occured as a result to the federally mandated transition to HIPAA Version 5010 electronic transactions on Jan.1".  Ms. Turney goes on to warn, "Should the government not take necessary steps, many practices face significantly delayed revenue, operational difficulties, a reduced ability to treat patients, staff layoffs, or even the prospect of closing their practice".

To read the full letter MGMA sent to HHS, please visit MGMA's website:http://www.mgma.com/WorkArea/DownloadAsset.aspx?id=1369699

So, What can you do?

Make sure your practice is monitoring any increase in claim rejections and denials by reviewing payer or vendor/clearing house reports.  Make sure you understand the requirements of HIPAA Version 5010 that can commonly affect claims:

• Use NPI Numbers: Social Security and employer identification  numbers are no longer accepted as primary identifiers
• Billing address Vs. Pay-to address: HIPAA Version 5010 requires a physical address in the billing field.  If a P.O. Box is used for payments, the address should be entered in the pay-to address field
• Use a nine digit zip code: Five digit zip codes are no longer accepted
• Drug reporting requirements: HIPAA Version 5010 requires a drug quanity and unit of measurement whenever a National Drug Code is listed on the claim
• Both primary and secondary claims MUST have a Medicare Secondary Payer indicator if Medicare is the secondary pay

We at Advanced Billing Consultants, Inc. are also strongly recommending that you call and contact your local Congressman/woman and inform them of this dire issue.  You can find them here: http://www.house.gov/.  We have also drafted a letter (requires MS Word, click enable editing -- let us know if you'd like another format), http://www.advancedbillingconsultants.com/fixhipaa5010.docx, to either help you with talking points with your Congressman/woman or to send on the behalf of the physician, the physician’s employee, and the insured patient.  We recommend you call, instead of email, and have a short conversation to make sure they are aware of how this issue is affecting the healthcare industry and the people of the United States.

When it comes to medical billing, integrity is key.  Physicians count on us to properly code and bill out claims to insurance companies for reimbursement; if we dont do our job, not only would we generate a bad name for ourselves, but also any physicians that we are affliated with.  Here at Advanced Billing Consultants, Inc., we pride ourselves in having employees that are honest and conscientious medical billers.  Our Passion Is Your Sucess; Choose Advanced Billing Consultants for your physician's medical billing services!

Below is an article from The United States Department of Justice about a unscrupulous medical billing management company, JJ&R:

 FOR IMMEDIATE RELEASE

In a continued effort to protect the privacy and security of TRICARE's 9.6 million beneficiaries, starting June 1, 2011, the Department of Defense (DoD) will no longer issue military ID cards with an individual's Social Security Number (SSN) as an identifier.

SSNs will be removed from ID cards and the DoD will issue new cards as individuals enlist or as a card expires. It is anticipated that there will be a four year transition time to issue all new cards.

SSNs will be replaced by two new numbers:

• DoD Identification Number (DoD EDI-PI or DoD ID): This unique 10-digit number is assigned to every person with a direct relationship with the DoD (as determined by having a record in the Defense Enrollment Eligibility Reporting System [DEERS]). This number already exists and is commonly known as the Electronic Data Interchange Person Identifier (EDI-PI).
• DoD Benefits Number (DBN): This 11-digit number will be used to determine benefits eligibility. The first nine digits are common to the sponsor; the last two digits identify the specific person, much like with a commercial benefit plan. The number can be found above the bar code on the back of the beneficiary's ID card.