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Biomedical subjects

M L McLure

Publications and source records attributed to M L McLure.

7 recordsLinked to original sources
PubMed2000

HIPAA brings new requirements, new opportunities.

The passage of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) brought with it the need for Federal rules to implement the act's simplification and cost-reduction efforts. HHS has published proposed rules related to security for the electronic transmission of health information, privacy of individually identifiable health information, transactions and code sets, and national provider and employer identifiers. Additional proposed rules will be published this year for claims attachments and health plan identifiers. Although HIPAA does not require providers to conduct business electronically, the new standards give providers the opportunity to reduce healthcare administrative costs significantly and undertake electronic commerce efficiently and cost-effectively.

Computer Security↗
PubMed1998

Payers required to adopt standardized electronic claims processing.

The Health Insurance Portability and Accountability Act of 1996 requires most claims payers to support electronic claims processing and uniform national standards for code sets and identifiers to streamline healthcare administration. The law will penalize payers that do not support the standards and are not prepared to conduct business electronically by the year 2000. Many providers may qualify as claims payers and, thus, will be subject to penalties if they do not adopt EDI for the transactions required by the Act. Providers also will have greater opportunity to eliminate paper, speed claims payments, and cut administrative overhead. Both providers and payers will have new guidelines for privacy and confidentiality, and violation of these guidelines will result in significant penalties. Consequently, all providers should become familiar with the legislation and evaluate their EDI strategy in light of new opportunities and responsibilities.

Chronology as Topic↗
PubMed1998

Eligibility and EDI create new opportunities.

A growing number of providers and payers are using EDI to automate the eligibility verification process. Some have integrated EDI eligibility verification into their patient scheduling routine. Others find it makes sense to integrate EDI eligibility into the patient registration process. Switching to electronic processing of eligibility information can make more information available faster to the many people involved in eligibility data processing. However, business office staff will have to be better trained to interpret eligibility data.

Diffusion of Innovation↗
PubMed1997

Streamlining the accounts payable function with EDI.

Kaiser Permanente of Southern California is expanding its use of EDI as a way to enhance the efficiency of its procurement effort and reduce administrative costs. Based on the results of surveys of key suppliers, Kaiser executives identified four EDI-based process improvements: 1) using the X12 832 standard to reconcile contracting data, which can eliminate up to 33 percent of mismatches among purchase orders, invoices, and receiving documents; 2) using procurement cards for many purchases, which can eliminate 20 percent of all invoices and related check payments; 3) using the X12 810 standard to obtain electronic invoices from Kaiser's largest suppliers; and 4) implementing the X12 820 standard, which lowers both supplier and claims payment costs.

Accounts Payable and Receivable↗
PubMed1995

The need to manage and reconcile capitation payments.

As capitation becomes a more common method of paying providers, healthcare financial managers must determine if these payments are being made correctly. The reconciliation process under capitation contracts is new for most financial managers. Standard industry conventions for payers and providers are needed to reduce the associated administrative costs for this type of payment. Recent efforts to create an American National Standards Institute (ANSI) X12 capitation payment standard have focused on provider information needs under capitated payment agreements. A solution is at hand if providers and payers can agree on a standard for reconciling capitation payments.

Capitation Fee↗
PubMed1995

Organizing for EDI.

In many ways, nontechnical issues of an electronic data interchange (EDI) initiative--such as organizational issues--can be more daunting and expensive than the technical issues of EDI implementation. Estimates are that the "human" costs associated with education, training, and implementation management constitute 90 percent of EDI implementation costs. In order to successfully implement EDI, a strategy is needed for managing the nontechnical, organizational issues involved in the process.

Attitude to Computers↗