Our company, Synergistic Office Solutions, was founded in 1985, 31 years ago. In those early years, writing practice management software was the easy part of the job. The challenging bit was creating custom claim forms for payers upon whom there were, at that time, no requirements for consistency. While electronic claim filing was possible, our customers who were willing to pursue that option were intrepid explorers. Not many went that far into the wilderness.
Then, in 1996, Congress passed a bipartisan bill aimed at allowing continuity of health insurance coverage for workers moving from one job to the next. That same bill adopted standards for claims and other electronic transactions and began the move toward a single paper claim form, the HCFA 1500 . . . with the huge goal of ‘Administrative Simplification.’
Twenty years ago, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) required the Department of Health and Human Services (HHS) to adopt national standards to improve the electronic exchange of health care data. This national standards mandate falls under a part of HIPAA called Administrative Simplification.
As noted in a recent blog post, in 1996 a considerable portion of every health care dollar was spent on administrative overhead for processes that involved:
- Numerous paper forms
- Telephone calls
- Nonstandard electronic commerce
- Many delays in communicating information among different locations
Since the 1996 passage of HIPAA, HHS has released numerous regulations to adopt required standards. Today 93.8% of all health care claims transactions are conducted in standard form. The standards have helped pave the way for the interoperability of health data to enhance the patient and provider experience.
For details about Administrative Simplification laws and regulations, view the CMS timeline.
For most of us today, HIPAA is likely to conjure up thoughts of protecting patient privacy and the security of patient data, PHI . . . what is often viewed as an increase in administrative responsibility rather than a simplification. But for those of us who have been around long enough to remember some of those unique paper forms, and the totally different claim file structures required by various clearinghouse companies and hundreds of payers, state and government entities, HIPAA has simplified our work. Even so, we do still have a long way to go before we can claim to have achieved anything like ‘administrative simplification.’
For those of you who have been in behavioral health practice or administration longer than twenty years, what are your memories of pre-HIPAA practice? Do you think the law has improved things for patients? What about for you?
Please share your comments below.
Susan Hasselle, APRN says:
I’ve respected the policies and believe I’ve been compliant without much effort. . . There have been times, however, when I have felt muzzled with parents of an adult child or a spouse of a patient. They usually have accepted my limits gracefully, though. Physicians and other professionals in my community seem to be compliant also.
Kathy says:
Thanks for sharing your experience, Susan. I am glad to hear that complying has not felt like a burden!
Cris Sorel, Practice Administrator, Karner Psychological says:
As a patient I think it is basically non-existent in most of my doctors’ offices. I always wonder how and why it continues to be ignored by so many practitioners. As a caregiver it has made my life complicated. As an administrator of a Behavioral Health Office we have tighten things up a little but basically we have always protected our patients’ privacy.
Kathy says:
I think behavioral health providers have always been much more careful of patient privacy, Cris. I too have been surprised in physician offices and outpatient surgery centers. It is as if they have forgotten what they are supposed to do! Thanks for sharing your experience.