The U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration funded the Institute of Medicine study.
New Medicare claims system readied
Stacks of paper in the medical records room will soon be a distant memory under the revamped Medicare Transaction System (MTS), which was set to take effect in December 1996.
Scheduled to be fully operational in 1999, the new system aims to create a single standard processing system for Medicare claims. The system will place greater emphasis on electronic data interchange, reduce regional variations in payment policies, speed claims processing, and make it easier for federal authorities to detect billing irregularities, Health Care Financing Administration (HCFA) officials say.
Other features of the new Medicare transactions include:
• Claims data from Part A, Part B, and Medicaid managed care plans will be integrated. The new system’s centralized nature will enable claims data to be processed by beneficiary rather than according to whether it’s a Part A or Part B claim.
• Provider identification numbers will be standardized.
• Federal authorities will find it easier to detect abusive billing practices because the MTS will eliminate the opportunity for duplicate billing.
Although the new system will be largely automated, support personnel will still be available to answer questions and provide information regarding claim status, HCFA officials say.
Along with its MTS, HCFA will establish standardized provider identification numbers, which will be recognized by all federal insurance programs, including Medicare.
The new 10-digit identification numbers, set to roll out this month (January), will also be recognized by private insurance programs. Under the new identification system, physicians will retain their numbers even if they change specialties or relocate, HCFA officials say.
In addition to the provider identification system, payers of health care claims will also receive new identifications. Under the new system, those payer ID numbers will be required on all claims submissions.
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