Feds get pressure to upgrade, expand HIPAA transactions

HIPAA transaction standards, first put in place nearly a quarter of a century ago, might benefit from a re-examination and revamp to reflect changes in the healthcare industry.

There is a push to simplify and improve the standards, says Stanley Nachimson, principal at Nachimson Advisors, a health information technology consultancy. The responsibility for doing so lies with the Department of Health and Human Services, which has infrequently updated some standards to reflect changes in technology.

He believes there are numerous reasons to study the standards. For example, the HIPAA eligibility verification standard doesn’t give providers enough information to decide if a specific service would be covered by insurance, so providers have to create their own workarounds to figure out eligibility status.

For the last 18 months, the National Committee on Vital and Health Statistics, a public advisory body to the Department of Health and Human Services, has been looking for ways to simplify HIPAA and recently sent a letter of recommendations to the Centers for Medicare and Medicaid Services.

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A key recommendation is to not create and publish new regulations using the formal notice of proposed rulemaking process, which is a very lengthy endeavor, but rather involve industry stakeholders to shorten the process for adopting new standards as technology changes, such as including a universal UPN product for a new medical device, or a new code set for alternative medical procedures, Nachimson explains.

Other NCVHS recommendations include:

* Promote and facilitate voluntary testing and use of new standards or emerging versions of transactions or operating rules.

* Improve the visibility and impact of the administrative simplification enforcement program.

* Provide policy-related guidance from HHS regarding administrative standards adoption and enforcement.

* Re-evaluate the function and purpose of Designated Standards Maintenance Organizations, which oversee a process of evaluating modifications to standards.

HIPAA was enacted as the industry was starting to move from paper to electronic data exchange, and the goals at that time were to standardize and encourage use of the electronic transactions to control costs and protect information, NCVHS tells CMS in the letter.

Now, more work remains to improve system efficiencies, according to NCVHS. “As industry and technology have evolved, some aspects of the process to develop and adopt standards have become impediments to, rather than drivers for, innovation,” the advisory body contends. “Simply stated, the processes take too long, contain unnecessary redundancies, are often opaque and lack accountability to those impacted.”



Further, the industry has not seen benefits from prior authorizations and attachments standards, because of regulatory processes and lack of regular communication from CMS, NCVHS tells the agency in its letter.

“For both pharmacy and non-pharmacy standards, either some of the current standards development or federal rulemaking processes have impeded agile implementation of programmatic or system updates essential for providers and health plans to keep pace with value-based purchasing arrangements, opioid epidemic-related strategies and other innovative opportunities. These missed opportunities, if addressed, could have reduced burden, decreased costs and improved care outcomes. NCVHS does not believe the current process is effective for either HHS or its stakeholders.”

The complete letter from NCVHS is available here.