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HIPAA
contained a section called Administrative Simplification, which was:
"intended to reduce the costs and administrative burdens of
health care by making possible the standardized, electronic
transmission of many administrative and financial transactions that
are currently carried out manually on paper."
The
goal of Title II, "HEALTH CARE ACCESS, PORTABILITY, AND
RENEWABILITY", Subtitle F is to reduce the administrative
component of health care costs through the implementation of electronic
data interchange (EDI) standards primarily by embracing ANSI X.12n
transaction formats.
The American National Standards Institute (ANSI) established a workgroup
in 1993 specifically for the purpose of defining EDI standards.
During the past 7 years WEDI (the Workgroup for EDI) has developed a
broad spectrum of EDI transaction formats for many industries, including
health care.
By all accounts and estimates, it is believed that as much as $26
billion may be saved by instituting X.12 EDI standards on an industry
wide basis. A significant portion of the $.20 per dollar, spent on
delivery and administration of health care services would disappear once
EDI is fully implemented.
Final rules and regulations are yet to be published. DHHS was
obligated by law to address all issues relating to this portion of the
law within 18 months after passage of HIPAA. This date come and
gone, however, only a few issues remain to be decided before a 'final
document" is published. Once published, the industry will
have two years to fully implement its requirements.
Implementation of the HIPAA Administrative Simplification Standards will
also require adoption of several supporting standards:
- Each entity involved
in health care transactions will be assigned an "Identifier".
Insurance plans, health care providers, employers providing group
coverage, and patients are among those entities covered under this
provision.. The most controversial is the patient identifier, often
referred to as the "Universal Patient
Identifier".
- Individually
Identifiable Health Information, the most common of which are the
patient medical record and insurance claims will now be monitored
under the
security provisions
of the law, and
- Standardized Code
Sets will also be required for both diagnostic and procedures codes.
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