NATIONAL COMMITTEE ON VITAL AND HEALTH STATISTICS (NCVHS)
Subcommittee on Standards
Hearing on HIPAA and ACA Administrative Simplification
– Operating Rules, ICD-10, Health Plan ID, Attachments –
Hubert H. Humphrey Building
Department of Health & Human Services
200 Independence Ave, SW, Room 705-A
Washington, DC 20024
Tuesday, June 10
Hearing Purposes, Objectives
The purpose of this hearing is to review and discuss the current status of selected administrative simplification topics that are a priority for NCVHS in 2014.
The objectives of this hearing are as follows:
- Receive and discuss the annual DSMO Report and review of the status of implementation of administrative transaction and code set standards
- Discuss the status of development of Operating Rules
- Review the status of the Coordination of Benefits transaction
- Discuss new developments in the use of credit cards (including virtual cards) for claim payment
- Review the Status of Standards Development of Attachments
- Discuss the planning and preparation of Health Plan ID
- Review and discuss the incorporation and use of a unique device indicator (UDI) in Administrative Transactions
- Discuss the status of ICD-10 Delay
(Each testifier will have 5 minutes followed by Sub-Committee Q&A at the end of each session)
|9:00 – 9:15 am||Welcome and Introductions||Standards Subcommittee Co-Chairs
Walter Suarez and Ob Soonthornsima
|9:15-10:00||Session 1: Regulatory Update, DSMO Report and Operating Rules
||Todd Lawson, OESS
Margaret Weiker, WEDI
Gwen Lohse, CORE
|10:00 -10:45||Session 2: Use of Credit Cards- Including Virtual Cards – for Claims Payment
|Matthew Albright, CMS
Heather McComas, AMA
Doug Downey, HCA
Priscilla Holland, NACHA
Sajid Imam, Visa, Inc.
Laura Burckhardt, ASC X12
|10:45 – 11:00||Break|
|10:45 – 11:40||Session 3: Coordination of Benefits
||Atul Pathiyal, CAQH
Sean Killeen, Kaiser
Laura Darst, Mayo
Mary Hyland – Cooperative Exchange (via phone)
|11:40 – 1:00||Session 4: Health Care Attachments Transaction Standard
|Durwin Day, HL7
John Quinn, HL7
Robert Dieterle, esMD
Gail Kocher, BCBSA
Don St. Jacques, Jopari
Tim McMullen, Coop. Exchange
Mary Hyland, Coop. Exchange (via phone)
Geoff Palka, Epic
|1:00 – 2:00 pm||LUNCH|
|2:00 – 3:30||Session 5: Use of UDI in Administrative Transactions
|Tom Gross, FDA
Greg W. Daniel, Brookings
Jean Narcisi, WEDI
Joshua Rising, PEW – Testimony
Stuart Kilpinen, Aetna
George Arges, AHA
Margaret Weiker, ASC X12
|3:30 – 4:30||Session 6: Health Plan ID
||Margaret Weiker, ASC X12
Laura Darst, WEDI
Debbie Meisner, Emdeon
Christol Green, Wellpoint
Gloria Davis, QSI/Nextgen
|4:30 – 4:40||Break|
|4:40 – 6:10||Session 7: ICD-10 Delay
|Denesecia Green, CMS
Jim Daley, WEDI
Holly Louie, HBMA
Sue Bowman, AHIMA
John Powers, BIDMC (via phone)
Nancy Spector, AMA
Sid Hebert, AHIP
John Evangelist, CMS (via phone)
Diane Kovach, CMS (via phone)
Godwin Odia, CMS (via phone)
Ronda Buckholtz, AAPC
|6:10 – 6:20||Public Comment|
Submitted Written Testimony
- Boost Payment Solutions
- Center for Research, et. al.
- Community Health Systems
- Geisinger Health System
- Leapfrog Group, et. al.
- Mercy Health System
- National Council for Prescription Drug Programs
- National Uniform Claim Committee
- Pew Charitable Trusts, et. al.
- Premier, Inc.
- Visa, Inc.
QUESTIONS FOR PANELISTS
Session 1: Regulatory Update, DSMO Report and Operating Rules
Objective: Receive an update on the status of Admin Simplification regulations, the DSMO Report and the status of Operating Rules for Remaining Transactions
- What is the status of regulations development?
- What is the status of the development of a regulatory roadmap?
- Summary of Public Comments received on Compliance Certification NPRM and estimated timeline for final rule
- What is the status of administration transaction standards updates
- CORE and Others (Operating Rules)
- What is the status of development of operating rules for all the remaining HIPAA transactions (Please specify for each transaction)
- Are there any priority areas for operating rule consideration with respect to specific transactions?
Session 2: Use of Credit Cards- Including Virtual Cards – for Claims Payment
Objective: To further understand the level of use and the core issues related to the use of credit cards – including virtual cards – in the payment of health care claims from payers to providers, and discuss ways to address those issues
- What is the level of use of credit card payment from payers to providers in the health care industry?
- What is the status of the issues associated with the use of virtual card in EFT transactions?
- What is the status of development of standards modifications to address credit card payment?
- What is the status of development of guidance and educational materials related to the use of credit cards – including virtual cards?
Session 3: Coordination of Benefits
Objective: To review the status of implementation of Coordination of Benefits across the health care industry, identify issues, and discuss ways to address those issues
- What is the current status of implementation of electronic coordination of benefits (COB) via v5010?
- What is the current model being followed (i.e. plan-to-plan COB, provider-to-provider COB, provider-to-plan COB)?
- Are there any issues with the implementation of electronic COB?
- What is the current status of development of Operating Rules applicable to COB?
- What are the top priority areas where Operating Rules are needed for COB?
- What are the key issues, from your perspective, that are occurring with COB, and how should we address them? (CAQH)
- What is the current status of Operating Rules for the COB transaction? (CAQH)
Session 4: Health Care Attachments Transaction Standard
Objective: To understand the latest developments in attachments standards, and consider any modifications to the original recommendations submitted by NCVHS in 2013
- What is the status of development of attachment standards?
- Have there been any significant changes since the Committee issued its recommendations – in terms of clinical data standard, enveloping/wrapper, transport/connectivity, etc?
- Has there been any message content changes or additions (new data sections, new codification of templates) needed to be incorporated into the standard?
- What are your perspectives with respect to alternative attachment standards being considered for balloting and approval?
- How are clinical data and administrative data exchanges taking place to help drive the quality and cost improvement and facilitate population health goals?
Session 5: Use of UDI in Administrative Transactions
Objective: To understand the purpose, benefits, value, and other considerations for the use of UDI in administrative transactions
- What is the current understanding of the purpose, value, and benefits of using UDI in administrative transactions, including Post-market surveillance, Cost/payment, Eligibility/prior authorization, Utilization analysis, Quality reviews, and other?
- What are the main challenges and issues in adopting and using UDI in administrative transactions?
- What is the current state of development of administrative transaction standards to accommodate for the capturing/reporting of UDI?
Session 6: Health Plan ID
Objective: To discuss issues pertaining to the adoption, use and benefits of the HPID
- What is the X12 HPID Errata?
- What are the main issues or concerns and challenges identified with respect to the use and implementation of Health Plan ID (from a provider, plan, clearinghouse, and vendor perspective)?
- What are some of the most salient strategies and ‘best practices’ for resolving these issues and challenges (from the same various perspectives?)
- What is the current status of preparation and health plan adoption of the new health plan ID in transactions?
- What is the current status of preparation and plan strategies for using new health plan ID in transactions?
- What are the key issues and challenges with the adoption of a health plan ID and Other Entity Identifier (OEID)? How are these issues being addressed?
- What is the impact on TPAs and ASOs of HPID and Certification of Compliance?
- How are controlling health plans being defined?
Sessions 7: ICD-10 Delay
Objective: To discuss the issues related to the delay in implementation of the ICD-10 codes
- What are the main challenges, issues and risks associated with the delay in the implementation of ICD-10?
- What is the impact of the new delay on the calculation of Medical Loss Ratio?
- What are the cost implications of the delay in implementation of ICD-10?
- What are the contingency plans being developed by organizations that had planned to implement ICD-10 by October 1, 2014?
- Would there be any benefit in allowing ICD-9 and ICD-10 to be used concurrently prior to the full implementation of ICD-10?
- What are the most important areas and opportunities to focus on during the delay period?
- Should the new deadline be 2015 or beyond 2015? Please explain.
- What are the implications of the delay for providers implementing Meaning Use?
- How has ICD-10 been incorporated in meaningful use?
- What is the impact of using diagnostic codes (ICD-9 or ICD-10) in meaningful use?
- What are the implications, impact of the ICD-10 delay? Business operations, systems, resources, financial?
- What must be done to ensure no further delay?
- What are the transition plans being considered by the ICD-10 Coordinating and Maintenance Committee, including continuation of the current code freeze?
Should you require reasonable accommodation, please contact the CDC Office of Equal Employment Opportunity on (301) 458-4EEO (4336) as soon as possible.
Times, topics, and speakers are subject to change. For final agenda, please call 301-458-4200 at NCHS or visit the NCVHS Home Page at http://www.ncvhs.hhs.gov
June 19, 2014