Nexsyis

HIPAA

The Health Insurance Portability & Accountability Act (HIPAA), passed by Congress in 1996, implements the use of standard formats for electronic claims and other administrative transactions. HIPAA governs any such items transmitted by health care providers, health plans and health care clearinghouses. These standard formats will simplify, improve efficiency, and encourage health care transactions to be conducted electronically. HIPAA required compliance with the Transaction & Code Set Standards by October 16, 2003.

That is the simplified translation of HIPAA. Unfortunately, putting HIPAA into effect has proven to be more difficult and costly than most physicians realized. Many practices do not truly understand how HIPAA affects their practice management software and are relying on their software vendor to become compliant. To put this in the simplest terms, your claims must arrive at the insurance carrier electronically in the ANSI format. The simplest and most efficient way for that to happen is for your software to produce claims in the ANSI format. Unfortunately, that is not happening throughout the industry. Many software vendors are sending claims to designated clearinghouses that then reformat the files into the ANSI format. They are then forwarded to the correct insurance carriers. In most cases, the physician is paying a premium price to file a transaction they could be filing for free. When the insurance carrier sends payment for the claims, they are also required to produce an electronic transaction. If you want to take full advantage of HIPAA, your software should have the ability to import that payment transaction electronically to the charge. This will result in significant administrative savings by not having to spend time posting payments manually.

Why not receive all the benefits to which you are entitled? Software vendors that reformat claim files are not allowing their clients to reap these benefits. Their clients do however, still pay all of the costs of HIPAA.

NEXSYIS was one of the first software vendors to pass testing for HIPAA. We are one of the few software vendors filing Medicare and Blue Shield through AdminaStar that are in the process of moving all of our clients to the ANSI format for HIPAA compliancy. Not only do we produce the ANSI file format directly from our software, we are also able to accept payments electronically. We don't use costly clearinghouses for Medicare, Medicaid, and Blue Shield. Our clients are able to benefit from all facets of the HIPAA law.

As HIPAA progresses, we will continue to update our software at no cost to our clients. This is just the first step in what will continue to be an evolving and ever-changing process.

If you have any additional questions regarding HIPAA, please feel free to give us a call. We may not have the answer, but we just might know somebody who does.