Critical Care Plus-HIPAA May be a Pain, but Could Produce a Gain
By Mary Booth Thomas
The health insurance portability and Accountability Act (HIPAA) will force physician practices to make sweeping changes in the way they do business, but it also could improve the bottom line.
"Nobody likes the government forcing them to accept new requirements, but the good news is that there is a positive return on your investment if you do transactions electronically," asserts Christopher Assif, CEO of Health Network Ventures, operator of Health.Net, an on-line network for medical professionals and office staff.
One intent of HIPAA is to encourage providers to transmit claims because it is cheaper and easier. When HIPAA regulations take effect, all transactions with third-party payers will be conducted in the same way. This means one method of checking eligibility, one set of treatment and procedure codes, and a standardized method of submitting claims.
The cost savings could be substantial, Assif says. "Physicians now spend money on operational expenses to keep people on their staff to call the insurance companies to verify a person"s benefits. That will no longer be necessary. They will be able to dial directly into the computer," adds Jon Zimmerman, solutions manager for Shared Medical Systems Corporation, a Malvern, PA, supplier of information systems and professional services for healthcare providers.
When HIPAA standards go into effect, you should get the correct information about your patients up front and be able to follow the plan rules. It should eliminate all the reimbursement problems that occur after the service has been provided, Zimmerman says.
For instance, at present, every time you don’t get the right eligibility or benefits information from the patient and your claim is rejected by the payer, it costs you money. If a patient gives you the wrong plan number by mistake and he’s not covered, the debt will sit on your balance sheet for months.
It has also become financially prudent for physicians to submit their claims electronically, notes John Knapp, a health law attorney with the Philadelphia law firm of Cozen and O’Connor. One big issue, the lack of speed with which third-party payers process claims, figures large into electronic transmission.
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