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Written by: Darlene D'Altorio-Jones (1959-2015) on Tuesday, January 29, 2013 Posted in: Inpatient Rehab

“To improve the efficiency and effectiveness of the health care system, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191, included Administrative Simplification provisions,” reported on the Health and Human Services website.

In warped speed, let me refresh the last 17 years and what has been accomplished with the various publications and rules set toward this Administrative Simplification process; as simple as it is not!

HHS published a final Privacy Rule in December 2000, which was later modified in August 2002. Compliance with the Privacy Rule was required as of April 14, 2003 (April 14, 2004 for small health plans). HHS published a final Security Rule in February 2003 with mandates for compliance in April 2005 and 2006 for smaller plans. With all this came finalEnforcement Rules in the Federal Register in February of 2006.  More promise of simplification led to National Provider Identification (2005),  Electronic Claims Submission (2003) and a slew of new acronyms we are slowly becoming use to. Recall simplification hatched all these new procedures and workflows.

  • NPI – National Provider Identification ( Effective 2005)
  • EDI – Electronic Data Interchange (Effective 2003) – Transactional Code Sets
    • Claim, encounter information, payment and remittance advice, claims status, eligibility, enrollment, disenrollment, referrals and authorizations
  • ICD-9 & ICD-10 (October 2013); largely utilized by now, more highly enforced for reporting, coding, payment
  • HCPCS – Anciillary Services – Health Care Procedural Code Sets
  • NDC – National Drug Codes
  • CDT – Current Dental Terminology
  • EIN -Unique Employers Identification Number (IRS)
  • NPI – National Provider Identifier (10 position)
  • ACA – Affordable Care Act (2010) brought HPID – Health Plan Identifier
  • EFF – Electronic Funds Transfer
  • RA – Remittance Advice
  • HITECH Act – Interim Final Rule (October 2009)

I am just not sure ‘Administrative Simplification’ was a great choice of words; although you can see how trying to communicate all of these very specific ideas across any number of home-brewed methodologies would never equate to any ability to share information toward advances we can only dream of now. I feel Lady Justice is getting a tired arm and the fact that she is blindfolded has most likely kept her sane with healthcare providers wishing they too could look the other way; that hasn’t been our fate at all and you can tell we’ve worked hard and steady as required to get to where we are now.

Reality is, we are 17 years into the master plan of administrative simplification. With every leap of new technology and privacy challenges, our eyes are more wide open then ever to stepping it up and getting it right!  The era of electronic documentation, data retrieval, sharing of information and expedited expectations are right here RIGHT NOW.  If you or your staff are still in denial it’s either time to retire or balance the scales of justice. We seem to be very aware of safety and security mandates but administrative simplification has been resisted for a variety of reasons, whether true or not, and pushed and pushed til the point where we must admit; WE ARE HERE!  Now is the time; 2013 and beyond will continue to fulfill expectations so that eventually, at the end of it all, we can feel this list of acronyms and the work it has held has simplified that half tilted promise toward level.

And if that dream doesn’t keep you up at night, we still have Congress and a looming March and fiscal cliff to climb.


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