HIPAA Transaction
Standards Final
The Department of
Health and Human Services (HHS) published its first in a series
of Health Insurance Portability and Accountability Act (HIPAA)
regulations August 17. The final rule on transactions and
code sets requires hospitals that bill insurers electronically
to use national data content and format standards when submitting
claims and for other administrative and financial health care
transactions, such as payment/remittance and eligibility.
All health plans, including Medicare and Medicaid, must accept
the standard transactions and codes. While the rule took effect
October 15, 2000, compliance is not required until October
16, 2002. The rule can be found at http://aspe.hhs.gov/admnsimp/final/txfinal.pdf.
The rule represents the first major block of HIPAA to
be put into place in several months. Other final HIPAA regulations,
including privacy, security, the national provider identifier,
the national employer identifier and an electronic signature
standard, are expected to be released in early 2001.
American Hospital Association advisories about HIPAA rules
may be accessed at www.aha.org,
clicking on the "HIPAA" icon.
Congress Passes
BBA Relief Bill
Congress passed a Balanced Budget Act relief package in
December that will restore $37 billion in Medicare payments
to healthcare providers over the next five years. New payments
for hospitals and hospital-based services are valued at $11.55
billion. The relief was included in the Medicare, Medicaid,
and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA),
which was passed as part of a larger appropriations measure
December 15. For Arkansas' hospitals, the BIPA could mean around
$100 million more in Medicare and Medicaid payments between
2001 and 2005.
Major components of the Act that will help hospitals include
the following:
- Medicare inpatient payments
will rise 3.1% in fiscal 2001. That's up from a 2.3% increase
allowed under the BBA. In 2002, payments will rise 3.05%,
up from about 2.5% that the BBA called for. The increased
payments should restore $3.7 billion to hospitals.
- About $900 million will
be restored to Medicare funding for calendar year 2001 via
a 4.4% increase in payments for outpatient services. Without
the BIPA, the increase would have been 2.4%.
- The BIPA requires a freeze
in the level of adjustment for indirect medical education
payments at 6.5% in FYs 2001 and 2002, adding $700 million
to hospital payments, and the floor for direct graduate
medical education payments will climb to 85% of the national
average, netting another $300 million.
- Payments for Medicare bad
debts jump from 55% to 70%, restoring $700 million.
- New Medicare and Medicaid
disproportionate share (DSH) provisions bring a combined
$2.6 billion in new payments.
The Act also includes
about $1.1 billion in more payments for rural, critical access,
Medicare-dependent, and long-term care hospitals as well as
rehabilitation and psychiatric hospitals and units. Other new
funds will be available to hospital-based home health agencies,
skilled nursing facilities and hospice programs.
AHIMA Comments
on Secure Records
The American Health
Information Management Association (AHIMA) has developed a set
of fundamental principles and list of operational tenets it
recommends as a blueprint for protecting the security of patients'
health records and ensuring the quality of that information
on the Web.
The three fundamental principals are:
- e-health organizations should
provide an easily understandable notice of their health
information practices that informs consumers what personal
health information is being collected, who is collecting
it and how it is being used;
- these organizations should
make it easy to collect authentic, accurate, timely and
complete individually identifiable personal health data;
and,
- they should maintain individually
identifiable personal health information in such a way that
ensures it is private, secure and retained or destroyed
only in accordance with the consumer's authorization or
applicable law.
AHIMA's list of
39 tenets and how they apply to providers, consumers and third
parties is available in the November/December issue of the Journal
of the AHIMA, and online at http://www.ahima.org/infocenter/guidelines/tenets.html.
Thanks
to Our 2000 Corporate Partners!
The Arkansas Hospital
Association wishes to thank the companies and organizations
participating in the 70th Annual Meeting and Trade
Show. With their financial support, high quality educational
programming is made possible for the AHA membership.
AAMSCO
Abbott Laboratories **
Accutemp Products, Inc.
Aetna Financial Services ****
AHA Services Inc. *****
Air Purification, Inc. (Alpine Products)
Airgas
Alberici
Alliant Food Service
AMCO (Arkansas Managed Care Organization)
American Business Forms
American Health Care Providers, Inc.
Ansell Perry
Aquarium Attractions
ArCom Systems
Arkansas Blue Cross Blue Shield ******
Arkansas Dietetic Association
Arkansas Foundation for Medical Care, Inc.****
Arkansas Health Care Access Foundation, Inc.
Arkansas Health Executives Forum ***
Arkansas Regional Organ Recovery Agency (ARORA)
Baird, Kurtz & Dobson, CPAs ****
B. Braun McGaw
BFI Waste Systems of North America, Inc.
Brentwood Health Management
BT Office Products
C & N Resource Group
Carstens
Cellular & Pager Warehouse
CompleteRx, Ltd.
Crews & Associates, Inc.
Datascope Corp.
Datron, Inc.
Diagnostic Imaging
Disability Determination for Social Security Administration
Ecolab Inc.
EDS **
Engelkes, Conner & Davis Ltd. *
Federation of American Health Systems
Federation of Associated Health Systems, Inc.
FORZA Marketing Group ****
Friday, Eldredge and Clark **
Freemyer Collection System
Gardner & White
Gideons International
Graduate Program in Health Services Administration - UALR
Great-West Family of Companies
Grinnell Fire Protection Systems
Hagan Newkirk & Hagan Agency
Healthcare Administration Technologies, Inc. ****
Healthstaf Medical Services
Herman Miller for Healthcare
Hewlett Packard Company
Hill-Rom
Hospital Building & Equipment Co.
Huntleigh Healthcare
Innovative Solutions Group, Inc.
Intermountain Health Care/AmeriNet
La-Z-Boy Concepts
Living Design, Inc.
Management Recruiters of Little Rock Healthcare Division
Marshall Erdman & Associates
Martin & Martin
MD Network
Medicaid Managed Care Services
Medical Employment Directory Inc.
Medical Management Consultants, Inc.
Medicus Resource Group, Inc.
MedPlus Leasing **
MEPA
Metlife Resources
Mobile Instrument Service & Repair, Inc. **
Modern Biomedical Services, Inc.
Moore Stephens Frost
MultiPlan, Inc.
Nabholz Construction
NovaSys Health Network
Osment Roofing Systems, Inc.
PHICO **
Press Ganey Associates, Inc. **
PriceWaterhouseCoopers ***
Publishing Concepts, Inc.
Pulaski Bank *
QualChoice/QCA Health Care Plan
Ramsey, Krug, Farrell & Lensing **
Ramtech Building Systems
RehabCare Group, Inc. **
RehabVisions
Rural/Metro Medical Services
Service Professionals, Inc.
ServiceMaster Diversified Health Services
Sign Systems, Inc.
Smart Solutions, Inc.
Snell Laboratory
Specialty Laboratories
Sprint PCS
Square One Rehab
St. Paul Fire & Marine Insurance Co.
Staffmark Medical Staffing
Stephens Inc. **
Sterling Health Care Group
Stonecrest Group
Stryker Medical
Sysco Food Services of Arkansas, Inc.
Tempur-Medical, Inc.
The Burrows Company
The Document Company, Xerox
The Merritt, Hawkins & Associates Group
The Ocoee Company
The Virginia Insurance Reciprocal ******
The Reciprocal Group
Ultimate Safety Inc.
Universal Hospital Services
VALIC
Vintage Health Resources, Inc.
Wittenberg, Delony & Davidson, Inc.
* Sponsor
** Host Sponsor
*** Bronze sponsor
**** Silver sponsor
***** Gold sponsor
****** Platinum sponsor
AHA, AFMC Discuss
Quality Study
The October 4 issue
of the Journal of the American Medical Association (JAMA)
included information from a recent study by the Health Care
Financing Administration (HCFA) about the quality of hospital
care delivered to Medicare beneficiaries. The HCFA study was
based on a sample set of data taken from national quality improvement
projects performed by the nation’s Medicare Peer Review Organizations
(PROs).
The JAMA article gives a snapshot of the clinical performance
in all 50 states, the District of Columbia, and Puerto Rico
of the care Medicare patients have received in hospitals for
heart attack, breast cancer, diabetes, heart failure, pneumonia,
and stroke. It compares clinical information collected the same
way across the country, showing significant state and regional
variations in how the care is provided. Arkansas, like most
southern states, is shown to have considerable room for improvement.
During a meeting with representatives of the Arkansas Hospital
Association (AHA), the Arkansas Medical Society and the Arkansas
Foundation for Medical Care (AFMC), William E. Golden, M.D.,
clinical coordinator of AFMC’s Health Care Quality Improvement
Program, said his organization "has already worked on some
of these measures and we have seen measurable improvement."
AFMC has initiated quality improvement projects in all six clinical
areas cited in the JAMA article with significant participation
among healthcare providers statewide. Dr. Golden also said the
report allows Arkansas to compare the performance of its hospitals
and physicians with national norms.
AHA president Jim Teeter said the study the first of
its kind will be useful in helping to assure the right
patient care is given in the right setting at the right time.
Noting that the JAMA report doesn’t claim that hospital
care in the U.S. or any state is bad, but that improvement is
clearly needed, Teeter said hospitals are always "committed
to improvement in every area of patient care."
The AHA, AFMC, and the Arkansas Medical Society agreed to work
together to promote better treatment and prevention through
collaborative quality improvement projects with healthcare providers
statewide.
Winter
2001 
