Laboratory News

New HIPAA Electronic Health Care Claims Attachment Rule: Is Your Lab Ready?

Laboratories should be preparing for the next big move in standardizing electronic claims.  In 2005, The Centers for Medicare & Medicaid services  (CMS) first proposed standards for electronic health care claims attachments.  Now, it appears that those standards will become the HIPAA Electronic Health Care Claims Attachments final rule in September 2008. 

A claim attachment is documentation supporting rationale, justification, or outcome of service.  It can include certifications, laboratory results, medical records, or images.  Claims attachments bridge the gap between billing and medical records functions.  The rule proposes standards to for the electronic request and receipt of additional healthcare information needed to support a claim. This additional information would be in the form of an electronic attachment to support healthcare claims data.

The goal of standardizing electronic claims attachments is to make the process of submitting and adjudicating claims more efficient by providing standardized data to payers.  The rule is expected to help payers increase the rate of automated adjudication, reduce administrative overhead, and result in reduced turn-around time on claims.  The first six standardized claims attachments will be for:  Ambulance, Emergency Department, Rehabilitative Services, Lab Results, Clinical Reports, and Medications.

 "You can imagine the time spent retrieving these claims and attaching them to send on to the payer, who then has to scan them in and read them manually," said Ana Croxton, Director of claims and EDI product management at NextGen.  The biggest impact of this rule is going to be for organizations that have a high number of pending claims.  To comply with the rule, a hospital can use document imaging, as well as EMRs, to attach the documents. 

The biggest challenge faced with getting the claims attachments rule finalized is defining the standard for communication.  Mike Davis, executive vice president of products and services at Chicago-based HIMSS Analytics, says that he believes hospitals should now be in a stage of looking at their patient billing and registration systems and their electronic information for the six areas of the rule to figure out how they're going to be able to get that information on the patient bill and on the claim.  The best place for hospitals to start is by talking to their EMR vendor.  If a hospital is trying to be proactive, they should be a year into their evaluation already. 

This rule is one more step on the road to full integration of clinical, billing, and administrative data. Laboratories have generally been among the first provider groups to have the capability to pass along data in electronic form. So, it is not expected that this new claims requirement will prove troublesome for the laboratory industry.

Related Items:

• Not Going Away:  The new HIPAA Electronic Health Care Claims Attachments rule is challenging, but understanding it can be lucrative 
• HIPAA Administrative Simplification: Standards for Electronic Health Care Claims Attachments; Proposed Rule