By Lee Barrett of EHNAC
There are major industry shifts already underway that will change how the payment and document industry transacts business. With the complexity of changes taking place in relation to how ARRA, HITECH and HIPAA affect our industries, every payment processor and document manager would be wise to keep a finger on the pulse of the hot topics of the day and trends that provide indication of future directions for the industry.
One important change is the fact that providers and banks will be able to provide reconciled data streams so that any needed claim adjustments can be minimized and there can be a marrying of the remittance and electronic funds transfer. The benefit of this reconciliation is that manual intervention becomes minimal for inputting data into accounts payable applications, and there are few additional contractual adjustments required as compared to the large number needed today. This is, of course, all to the benefit of the provider organization and ultimately the patient or payer.
The second recent trend is, in fact, the revitalization of an old trend. With the ever-increasing cost of health insurance, organizations are seeking more economical solutions to meet the needs of their employees. As a result of this, the industry is seeing healthcare savings plans regaining traction at a significant rate. Health savings accounts or HSAs are most frequently used in conjunction with a benefit debit card, and give employees the benefit of being able to put pre-tax dollars toward deductible payment or coverage of other health related services. Given the complexities of HITECH, HIPAA and COBRA, organizations and financial institutions offering HSAs are required to keep track of changing regulations regarding excise taxes and concerns related to health and financial data security, privacy and confidentiality.
A third recent trend the industry is witnessing arises from the consumer demand for transparency in their healthcare experience, and the desire to have all healthcare payment and records available through a single portal. These “Wealth Care portals” provide for connections and efficient processing of all healthcare needs for a patient, allowing a patient to determine what they owe different providers, by tracking their invoices and payments through a single site. These portals would also give patients the ability to make better-informed decisions, make use of calculators and tools to determine costs and savings and track the status of claims made to their health insurance.
The electronic healthcare and payment-document processing worlds are changing rapidly, with exciting developments coming to light almost daily. To ensure that these trends truly benefit our own customers, it makes sense to stay abreast of the changes, and constantly analyze what the changes mean to our organizations as well as to our stakeholders.
Lee Barrett is executive director of the Electronic Healthcare Network Accreditation Commission (EHNAC).
Showing posts with label HITECH. Show all posts
Showing posts with label HITECH. Show all posts
Wednesday, November 17, 2010
Friday, September 24, 2010
"What are you doing here?"
By Greg Lusch (glusch@ibml.com), ibml (www.ibml.com)
With all of the banks and financial services companies participating in this week's Healthcare Payments Automation Summit (HPAS) in Boston, the healthcare providers and payers in attendance could be excused for momentarily thinking that they were in the wrong place. But they weren't, and neither were their fellow attendees from banking and financial services.
When a single market represents a whopping 17 percent of the country's Gross Domestic Product (GDP) -- as healthcare does -- lots of companies will be looking for ways to cash in. Banks and financial services companies are no exception. And based on my conversations at HPAS, more providers are open to help from banks in automating healthcare payments.
For instance, there was a lot of conversation at HPAS about adapting bank lockbox services to process explanation of benefits (EOBs) and other medical documents. According to the results of a survey released by IAPP-TAWPI at the event, 34 percent of healthcare providers already use a bank lockbox for healthcare payments. Undaunted by the increased security and privacy regulations under the HITECH Act, it is clear that even more banks are pushing forward with lockbox services aimed squarely at hospital and physician practice groups. In fact, the participants on a panel at the event unanimously predicted that the percentage of providers that use a bank lockbox would climb, while a speaker in another session said he expected "slow but steady" growth for both bank and provider-based EOB solutions.
And if HPAS is any indication, banks also are making headway with remote deposit capture (RDC) solutions targeted at the healthcare space, namely, rising patient self-pay and co-insurance/co-payment obligations. According to the IAPP-TAWPI survey released at HPAS, 22 percent of providers currently use RDC. Several vendors of RDC solutions exhibited at the event (Creditron, EPSON and WAUSAU were among them), and a few providers shared case studies of their experiences with the technology as part of the conference agenda (faster funds availability was cited as a key benefit). A common refrain among healthcare providers at HPAS was that lower bank fees have greatly improved the business case for RDC, while banks have done a better job of adapting their solutions to the unique needs of providers.
The role of banks in the healthcare space also was a dominant -- and sometimes heated -- topic during the Healthcare Payments Council meeting that immediately followed HPAS.
The good news for banks looking to crack the healthcare space is that most HPAS attendees believe that while automated payment transactions (claims, remittances and payments) will continue to make gains, paper will be a fact of life in the industry for the foreseeable future.
And that is why banks were at HPAS.
With all of the banks and financial services companies participating in this week's Healthcare Payments Automation Summit (HPAS) in Boston, the healthcare providers and payers in attendance could be excused for momentarily thinking that they were in the wrong place. But they weren't, and neither were their fellow attendees from banking and financial services.
When a single market represents a whopping 17 percent of the country's Gross Domestic Product (GDP) -- as healthcare does -- lots of companies will be looking for ways to cash in. Banks and financial services companies are no exception. And based on my conversations at HPAS, more providers are open to help from banks in automating healthcare payments.
For instance, there was a lot of conversation at HPAS about adapting bank lockbox services to process explanation of benefits (EOBs) and other medical documents. According to the results of a survey released by IAPP-TAWPI at the event, 34 percent of healthcare providers already use a bank lockbox for healthcare payments. Undaunted by the increased security and privacy regulations under the HITECH Act, it is clear that even more banks are pushing forward with lockbox services aimed squarely at hospital and physician practice groups. In fact, the participants on a panel at the event unanimously predicted that the percentage of providers that use a bank lockbox would climb, while a speaker in another session said he expected "slow but steady" growth for both bank and provider-based EOB solutions.
And if HPAS is any indication, banks also are making headway with remote deposit capture (RDC) solutions targeted at the healthcare space, namely, rising patient self-pay and co-insurance/co-payment obligations. According to the IAPP-TAWPI survey released at HPAS, 22 percent of providers currently use RDC. Several vendors of RDC solutions exhibited at the event (Creditron, EPSON and WAUSAU were among them), and a few providers shared case studies of their experiences with the technology as part of the conference agenda (faster funds availability was cited as a key benefit). A common refrain among healthcare providers at HPAS was that lower bank fees have greatly improved the business case for RDC, while banks have done a better job of adapting their solutions to the unique needs of providers.
The role of banks in the healthcare space also was a dominant -- and sometimes heated -- topic during the Healthcare Payments Council meeting that immediately followed HPAS.
The good news for banks looking to crack the healthcare space is that most HPAS attendees believe that while automated payment transactions (claims, remittances and payments) will continue to make gains, paper will be a fact of life in the industry for the foreseeable future.
And that is why banks were at HPAS.
Sunday, February 28, 2010
Start ARRA Awareness Training Now
By Mark Brousseau
If they haven’t done so already, companies in the healthcare space should conduct organizational awareness training on ARRA and HITECH, Mary Rita Hyland, AVP, regulatory affairs, The SSI Group, Inc., told attendees at the Medical Banking Project Boot Camp at HIMSS10 this afternoon.
Organizations also should conduct a HIPAA and HITECH gap analysis to identify any products, procedures and services that need to be updated and modified, Hyland told attendees. As part of this exercise, organizations need to identify and coordinate technical or product updates, as well as coordinate and implement policy and procedural updates. “Operationally, ensuring compliance with HITECH’s security and privacy provisions is, to a large degree, an IT function,” Hyland noted.
Once they’ve reviewed their systems, policies and procedures, organizations need to audit and assess their compliance. “You don’t want to wait for an audit to be done on you by a whistleblower or someone else in the industry who doesn’t believe you are in compliance,” Hyland warned. “Audits are going to be important in meeting the guidelines and maintaining your compliance.”
If they haven’t done so already, companies in the healthcare space should conduct organizational awareness training on ARRA and HITECH, Mary Rita Hyland, AVP, regulatory affairs, The SSI Group, Inc., told attendees at the Medical Banking Project Boot Camp at HIMSS10 this afternoon.
Organizations also should conduct a HIPAA and HITECH gap analysis to identify any products, procedures and services that need to be updated and modified, Hyland told attendees. As part of this exercise, organizations need to identify and coordinate technical or product updates, as well as coordinate and implement policy and procedural updates. “Operationally, ensuring compliance with HITECH’s security and privacy provisions is, to a large degree, an IT function,” Hyland noted.
Once they’ve reviewed their systems, policies and procedures, organizations need to audit and assess their compliance. “You don’t want to wait for an audit to be done on you by a whistleblower or someone else in the industry who doesn’t believe you are in compliance,” Hyland warned. “Audits are going to be important in meeting the guidelines and maintaining your compliance.”
ARRA: A Whole New World
By Mark Brousseau
Last year was a year of transition for HIPAA, medical privacy and medical banking, Richard D. Marks of McLean, VA-based Patient Command, Inc. (www.patientcommand.com), told attendees this afternoon at the Medical Banking Project Boot Camp at the HIMSS10 conference in Atlanta.
“ARRA changes the rules for security of health information in the United States,” Marks said. “It creates an entirely new framework because it changes HIPAA so much and because it changes privacy in medical records. And, most significantly, it changes the whole approach to enforcement.”
“It’s fair to say that for the last decade, there has not been any real attempt on the part of the federal government to enforce HIPAA,” Marks explained. “ARRA changes that. What it brings into law, for the first time, is the hierarchy of diligence and culpability. There are increased, tiered civil and criminal monetary penalties, topping out at $50,000 per violation, with an annual limit of $1,500,000. These numbers are enough to get your attention. But the statute also includes civil and criminal liability for individuals, as well as organizations. Which individuals, you ask? Well, it could be you! And some people won’t figure this out, and you will see some prosecutions,” Marks predicted.
Integrated health information security is inherent in ARRA, Marks added.
References in business associate contracts now, by law, apply mutually to covered entities and business associates, Marks pointed out. “The impact of that is to rebalance all of the risk allocation that is in these agreements, and it creates a whole new set of possibilities for liabilities. Some folks will be less affected than others. But some of you will be affected will be enormously,” Marks said.
For instance, security is now an active responsibility of the board of directors and senior executives, if you are doing anything that touches healthcare, Marks said. “If you’re a public company you’ve really go to ask yourself how you do disclosure when you have to take on a much greater risk for your information systems,” Marks said. “What this all means is that you must have integrated, shared systems security that is comprehensive and fast, and upgraded from what you now have.”
Some of the changes in ARRA won’t go into effect until 2011. “But some of this is in effect now, because people, such as ambitious state attorneys general, are going to start enforcing HIPAA,” Marks said. “The bottom line is that ARRA makes it a whole new world in healthcare.”
Last year was a year of transition for HIPAA, medical privacy and medical banking, Richard D. Marks of McLean, VA-based Patient Command, Inc. (www.patientcommand.com), told attendees this afternoon at the Medical Banking Project Boot Camp at the HIMSS10 conference in Atlanta.
“ARRA changes the rules for security of health information in the United States,” Marks said. “It creates an entirely new framework because it changes HIPAA so much and because it changes privacy in medical records. And, most significantly, it changes the whole approach to enforcement.”
“It’s fair to say that for the last decade, there has not been any real attempt on the part of the federal government to enforce HIPAA,” Marks explained. “ARRA changes that. What it brings into law, for the first time, is the hierarchy of diligence and culpability. There are increased, tiered civil and criminal monetary penalties, topping out at $50,000 per violation, with an annual limit of $1,500,000. These numbers are enough to get your attention. But the statute also includes civil and criminal liability for individuals, as well as organizations. Which individuals, you ask? Well, it could be you! And some people won’t figure this out, and you will see some prosecutions,” Marks predicted.
Integrated health information security is inherent in ARRA, Marks added.
References in business associate contracts now, by law, apply mutually to covered entities and business associates, Marks pointed out. “The impact of that is to rebalance all of the risk allocation that is in these agreements, and it creates a whole new set of possibilities for liabilities. Some folks will be less affected than others. But some of you will be affected will be enormously,” Marks said.
For instance, security is now an active responsibility of the board of directors and senior executives, if you are doing anything that touches healthcare, Marks said. “If you’re a public company you’ve really go to ask yourself how you do disclosure when you have to take on a much greater risk for your information systems,” Marks said. “What this all means is that you must have integrated, shared systems security that is comprehensive and fast, and upgraded from what you now have.”
Some of the changes in ARRA won’t go into effect until 2011. “But some of this is in effect now, because people, such as ambitious state attorneys general, are going to start enforcing HIPAA,” Marks said. “The bottom line is that ARRA makes it a whole new world in healthcare.”
Monday, February 15, 2010
Healthcare Standardization
Posted by Mark Brousseau
Standardization of industry practices is critical to the strength of the healthcare market. Lee Barrett, executive director of the Electronic Healthcare Network Accreditation Commission (EHNAC) explains:
As the healthcare industry continues to evolve to meet regulations and requirements outlined in ARRA, HITECH and HIPAA, more than ever, there’s need for standardization of industry practices and optimization of stakeholder cooperation. Coupled with the complex issues surrounding interoperability, privacy, security and access is the fact that healthcare networks, financial service firms, payer networks, e-Prescribing and other solution providers and vendors need to overtly demonstrate their readiness, competence and capability to address these issues and comply with a complex web of regulations.
When any industry goes through the process of defining the standards to which industry participants should adhere, that industry becomes stronger in its own operations and earns greater respect from affiliated and external stakeholders. This is precisely the case with the electronic healthcare transaction industry.
EHNAC, or the Electronic Healthcare Network Accreditation Commission, is focused on establishing, developing, updating and filtering the criteria that define whether organizations operating in the healthcare electronic transaction industry receive accreditation or not. Through a dialogic process, that builds on stakeholder recommendations, insights and comments, EHNAC develops and promotes criteria for best practices, which focus on simplifying administrative processes, maintaining open competition and enhancing operational integrity.
In January, EHNAC announced the finalization and adoption of program criteria for 2010. This announcement concluded a 60-day public comment period for the following programs:
1. ASPAP-EHR – Application Service Provider Accreditation Program for Electronic Health Records
2. ePAP – e-Prescribing Accreditation Program
3. FSAP EHN – Financial Services Accreditation Program for Electronic Health Networks
4. FSAP Lockbox – Financial Services Accreditation Program for Lockbox Services
5. HNAP EHN – Healthcare Network Accreditation Program for Electronic Health Networks
6. HNAP Medical Biller – Healthcare Network Accreditation Program for Medical Billers
7. HNAP TPA – Healthcare Network Accreditation Program for TPAs
8. HNAP-70 – Healthcare Network Accreditation Plus Select SAS 70© Criteria Program
9. OSAP – Outsourced Services Accreditation Program
In addition, the commission developed draft criteria for Health Information Exchange (HIE) entities. In February, this draft criteria was released for 60-day public comment and review and will be finalized during the second quarter 2010.
The issues addressed through the criteria review and approval process become increasingly complex, as the industry responds to specific provisions in the federal acts. Criteria for accreditation programs today address health data processing response times and security; privacy and confidentiality for financial service providers; and e-Prescribing timeliness and security. As regulatory guidelines become more complex, industry participants are called on to make sure their operations are simplified, secure and compliant.
Accreditation also simplifies the process of discerning between those who are adhering to industry standards, and those who are not.
Standardization of industry practices is critical to the strength of the healthcare market. Lee Barrett, executive director of the Electronic Healthcare Network Accreditation Commission (EHNAC) explains:
As the healthcare industry continues to evolve to meet regulations and requirements outlined in ARRA, HITECH and HIPAA, more than ever, there’s need for standardization of industry practices and optimization of stakeholder cooperation. Coupled with the complex issues surrounding interoperability, privacy, security and access is the fact that healthcare networks, financial service firms, payer networks, e-Prescribing and other solution providers and vendors need to overtly demonstrate their readiness, competence and capability to address these issues and comply with a complex web of regulations.
When any industry goes through the process of defining the standards to which industry participants should adhere, that industry becomes stronger in its own operations and earns greater respect from affiliated and external stakeholders. This is precisely the case with the electronic healthcare transaction industry.
EHNAC, or the Electronic Healthcare Network Accreditation Commission, is focused on establishing, developing, updating and filtering the criteria that define whether organizations operating in the healthcare electronic transaction industry receive accreditation or not. Through a dialogic process, that builds on stakeholder recommendations, insights and comments, EHNAC develops and promotes criteria for best practices, which focus on simplifying administrative processes, maintaining open competition and enhancing operational integrity.
In January, EHNAC announced the finalization and adoption of program criteria for 2010. This announcement concluded a 60-day public comment period for the following programs:
1. ASPAP-EHR – Application Service Provider Accreditation Program for Electronic Health Records
2. ePAP – e-Prescribing Accreditation Program
3. FSAP EHN – Financial Services Accreditation Program for Electronic Health Networks
4. FSAP Lockbox – Financial Services Accreditation Program for Lockbox Services
5. HNAP EHN – Healthcare Network Accreditation Program for Electronic Health Networks
6. HNAP Medical Biller – Healthcare Network Accreditation Program for Medical Billers
7. HNAP TPA – Healthcare Network Accreditation Program for TPAs
8. HNAP-70 – Healthcare Network Accreditation Plus Select SAS 70© Criteria Program
9. OSAP – Outsourced Services Accreditation Program
In addition, the commission developed draft criteria for Health Information Exchange (HIE) entities. In February, this draft criteria was released for 60-day public comment and review and will be finalized during the second quarter 2010.
The issues addressed through the criteria review and approval process become increasingly complex, as the industry responds to specific provisions in the federal acts. Criteria for accreditation programs today address health data processing response times and security; privacy and confidentiality for financial service providers; and e-Prescribing timeliness and security. As regulatory guidelines become more complex, industry participants are called on to make sure their operations are simplified, secure and compliant.
Accreditation also simplifies the process of discerning between those who are adhering to industry standards, and those who are not.
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