Jun

20

Administrative Simplification – What Happened to Communication?

Once again I have been remiss in not keeping up with my sometimes opinionated web blogs. For those out there who read my blogs, I do apologize and will strive to do better in the future. That said, my rant today is that infamous topic called administrative simplification (or in army terms, SNAFU). The well intentioned efforts of Congress, the US Department of Health & Human Services (HHS) and the healthcare industry have yet to really achieve that much talked about cost savings called health care administrative simplification embodied in the HIPAA Administrative Simplification Provisions.

Based on a meeting I chaired yesterday of an industry group of health plans, providers and assorted others, in many cases it appears to come down to something very simple. It’s called communication (the problem being the lack thereof). We had a lively discussion of the issues providers and health plans are encountering in attempting to work with national provider identifiers (NPI) only versus using old legacy numbers assigned by health plans. One provider opined it was actually easier to conduct business before the advent of NPI which is a sad statement in and of itself.

After discussing the issues facing both health plans and providers, we came to the conclusion that a number of the problems could be resolved by simply sitting down and talking through the issues because the solutions did not appear to be all that complex. Unfortunately there is sometimes a significant disconnect between those who are actually tasked with things like making sure claims are processed and paid (both health plans and providers) and the senior level of management who’s mind is elsewhere or is not overly hot on talking to the completion.

I think it’s time to take a step back and do two things – internally review business processes to determine where internal streamlining can be accomplished and actually implementing changes in the healthcare administrative data exchange process. We’ve spent a lot of time talking and everyone (including me) has done their share of complaining but we are not making the strides that will lead to noticeable reductions in the cost of electronically exchanging healthcare information for administrative purposes.

Unfortunately the current version of transactions has its own problems which do include too much flexibility in some transactions (those wonderful situational fields). This one cuts both ways – different health plans are requiring providers use different situational fields and different approved transaction codes and, on the other hand, larger providers have a tendency to push for a data exchange process that serves that provider rather than supporting a standardized method of exchanging data. Let’s do more than sit down and talk. I think it’s time to actually do something and this is one of those initiatives that needs buy in, support and funding from the senior levels of the organization.