Final Agenda

National Committee on Vital and Health Statistics (NCVHS)
Subcommittee on Standards
Review Committee

Hearing on Adopted Transaction Standards, Operating Rules, Code Sets & Identifiers

National Center for Health Statistics
3311 Toledo Road, Auditorium A&B
Hyattsville, Maryland 20782

Printable Acrobat Agenda

June 16-17, 2015

Meeting Summary

Review Committee Findings and Recommendations on Adopted Standards and Operating Rules

ONC’s Draft 2017 Interoperability Standards Advisory

Hearing Purposes, Objectives

The purpose of this hearing is to obtain information from the health care industry on the currently adopted standards, operating rules, code sets and identifiers used in administrative simplification transactions.

The objectives of this hearing are as follows:

  • Review currently adopted standards, operating rules, code sets and identifiers used in each of the HIPAA-named administrative simplification transactions and evaluate the degree to which they meet current industry business needs.
  • Identify transactions, standards, operating rules, code sets and identifiers used in administrative simplification that require changes, deletions or new versions in order to meet industry needs.

Background on the Review Committee, including the Review Committee’s Charter can be accessed at http://ncvhs.hhs.gov/subcommittees-work-groups/subcommittee-on-standards/review-committee/

We invite the public to prepare and submit written testimony on any and all areas covered by this hearing. We also invite testifiers to prepare and submit more extensive written testimony, in addition to the oral testimony they will be providing during the hearing

 

Agenda

DAY 1 – Tuesday June 16, 2015

(Note: Unless noted, all testifiers will have 5 minutes to provide oral testimony; additional written testimony can be provided and will be entered into the record)

9:00 – 9:15 AM Welcome and Introductions Mr. Ob Soonthornsima and Ms. Alix Goss
Review Committee Co-Chairs
9:15 – 9:30 AM Overview of the Review Committee & Purpose of the Hearing Review Committee Co-Chairs
  • Legislative background and brief introduction to the Review Committee
  • Process and Logistics of the hearing
9:30 – 10:20 AM PANEL 1 – HEALTH PLAN ENROLLMENT/DISENROLLMENT AND HEALTH PLAN PREMIUM PAYMENT
Health Plan Don Petry, BCBS TN
Health Plan Gail Kocher, BCBSA
Employer Debra Strickland, Xerox
ASC X12 Stacey Barber
Pharmacy Annette Gabel, ACAG Consulting/NCPDP
10:20 – 10:30 AM Public Comment
10:30 – 10:50 AM Review Committee Q&A
10:50 – 11:05 AM Break
11:05 – 12:00 PM PANEL 2 – HEALTH PLAN ELIGIBILITY, BENEFITS INQUIRY & RESPONSE (PART 1)
WEDI Laurie Darst
Provider George Arges, AHA
Provider Robert Tennant, MGMA
Billing Dave Nicholson, HBMA
VA Ruth-Ann Phelps
Mental Health Benjamin Miller, PsyD, UC Denver
Pharmacy Annette Gabel, ACAG Consulting/NCPDP
Clearinghouse Sherry Wilson, Cooperative Exchange
12:00 – 1:00 PM LUNCH
1:00 – 1:50 PM PANEL 2 – HEALTH PLAN ELIGIBILITY, BENEFITS INQUIRY & RESPONSE (PART 2)
Health Plan Merri-Lee Stine, AETNA/AHIP
Health Plan Gail Kocher (BCBSA)
Long Term Care Stephanie Eades, AHIP
Medicare Rich Cuchna CMS via Telephone
Medicaid Melissa Moorehead, MPHI
Practice Management Vendors Chris Bruns, HATA
Operating Rule Authoring Entity Gwen Lohse, CAQH CORE
ASC X12 Stacey Barber
1:50 – 2:00 PM Public Comment
2:00 – 2:20 PM Review Committee Q&A
2:20 – 2:35 PM BREAK
2:35 – 4:00 PM PANEL 3 – PRIOR AUTHORIZATION
WEDI Sam Rubenstein
Health Plan Rhonda Starkey, Harvard Pilgrim Health Care/AHIP
Health Plan Gail Kocher, BCBSA
Medicare Connie Leonard, CMS via telephone
Medicaid Melissa Moorehead, MPHI
Provider George Arges, AHA
Provider Heather McComas, AMA
Provider Robert Tennant, MGMA
Mental Health Benjamin Miller, PsyD, UC Denver
Pharmacy Margaret Weiker, NCPDP
Clearinghouse Sherry Wilson, Cooperative Exchange
Practice Management Vendor Chris Bruns, HATA
ASC X12 Stacey Barber
4:00 – 4:10 PM Public Comment
4:10 – 4:40 PM Review Committee Q & A
4:30 PM DAY 1 ADJOURNMENT

 

 

DAY 2 – Wednesday June 17, 2015

(Note: Unless noted, all testifiers will have 5 minutes to provide oral testimony; additional written testimony can be provided and will be entered into the record)

8:00 – 8:15 AM Opening statement & Introduction Review Committee Co-Chairs
8:15 – 9:05 AM PANEL 4 – HEALTH CARE CLAIM OR EQUIVALENT ENCOUNTER INFORMATION (Part 1)
Health Plan Gail Kocher, BCBSA
Medicare John Evangelist, CMS via telephone
Medicaid Melissa Moorehead, MPHI
Provider George Arges, AHA
Provider Robert Tennant, MGMA
Dental David Preble, DDS, JD ADA
Mental Health Benjamin Miller, PsyD, UC Denver
9:05 – 9:40 AM PANEL 4 – HEALTH CARE CLAIM OR EQUIVALENT ENCOUNTER INFORMATION (PART 2)
Pharmacy Margaret Weiker, NCPDP
Clearinghouse Sherry Wilson, Cooperative Exchange
Practice Management Vendor Chris Bruns, HATA
ASC X12 Stacey Barber
Coders Raemarie Jimenez, AAPC
9:40 – 9:55 AM Break
9:55 – 10:05 AM Public Comment
10:05 – 10:25 AM Review Committee Q & A
10:25 – 11:20 AM PANEL 5 – COORDINATION OF BENEFITS
CAQH Atul Pathiyal
Medicaid Melissa Moorehead, MPHI
Provider George Arges, AHA
Medicare Supplemental Carrier Gary Beatty, AHIP
Provider Robert Tennant, MGMA
Clearinghouse Sherry Wilson, Cooperative Exchange
ASC X12 Stacey Barber
Practice Management Vendor Chris Bruns, HATA
11:20 – 11:30 PM Public Comment
11:30 – 11:50 PM Review Committee Q&A
11:50 – 12:50 PM LUNCH
12:50 – 1:40 PM PANEL 6 – HEALTH CARE CLAIM STATUS
Operating Rule Authoring Entity (ORAE) Gwen Lohse, CAQH CORE
Provider George Arges, AHA
Provider Robert Tennant, MGMA
Health Plan Rhonda Starkey, Harvard Pilgrim Health Care/AHIP
Health Plan Gail Kocher, BCBSA
Medicare John Evangelist, CMS via telephone
Clearinghouses Sherry Wilson, Cooperative Exchange
WEDI Jean Narcisi
1:40 – 1:50 PM Public Comment
1:50 – 2:10 PM Review Committee Q&A
2:10 – 2:25 PM BREAK
2:25 – 4:00 PM PANEL 7 – HEALTH CARE PAYMENT, REMITTANCE ADVICE AND ELECTRONIC FUND TRANSFER
WEDI Jean Narcisi
Operating Rule Authoring Entity (ORAE) Gwen Lohse, CAQH CORE
NACHA Priscilla Holland via telephone
Provider George Arges, AHA
Provider Heather McComas, AMA
Provider Robert Tennant, MGMA
Dental David Preble, DDS, JD ADA
Long Term Care Stephanie Eades, AHIP
Health Plan Merri-Lee Stine, Aetna/AHIP
Health Plan Gail Kocher, BCBSA
VA Ruth-Ann Phelps
Medicare John Evangelist, CMS via telephone
Medicaid Melissa Moorehead, MPHI
Pharmacy Annette Gabel, ACAG Consulting/NCPDP
Clearinghouses Sherry Wilson, Cooperative Exchange
ASCx12 Stacey Barber
4:00 – 4:10 PM Public Comment
4:10 – 4:30 PM Review Committee Q&A
4:30 – 5:00 PM Review Committee Discussion of Key Themes, Findings, and Next Steps
5:00 PM ADJOURNMENT

 Written Only Testimony

 

QUESTIONS FOR PANELISTS

GENERAL QUESTIONS TO ALL PANELISTS APPLICABLE TO ALL PANELS

  • VALUE – Overall, does the currently adopted transactions meet the current (and near-term) business needs of the industry? Please provide as much as possible any evidentiary information (qualitative or quantitative) to support your viewpoints
  • VALUE – Overall, do the standards, code sets, and identifiers adopted for each transaction meet the current (and near-term) business needs of the industry? Is the industry achieving the intended benefits from the transactions and their corresponding standards, code sets and identifiers?   Please provide as much as possible any evidentiary information (qualitative or quantitative) to support your viewpoints
  • VALUE – Have there been any studies, measurement or analysis done that documents the extent to which the transactions and their corresponding standards, code sets and identifiers, as adopted and in use, have improved the efficiency and effectiveness of the business processes? Please provide, as much as possible, information for specific transactions.
  • VOLUME – What is the current volume / percentage / proportion of business transactions being conducted electronically (each transaction) using the adopted standard?
  • BARRIERS – Are there any known barriers (business, technical, policy, or otherwise) to using the transactions, standards, or operating rules?
  • BARRIERS – Is there any perceived or qualified degrees of variability in stakeholders’ usage of adopted transactions and operating rules?
  • BARRIERS – What is the qualified or quantified degree of difficulty in adopting and expanding the usage of the transactions and operating rules
  • ALTERNATIVES – Are there any known perceived or qualified availability and acceptance of other methods / approaches in achieving the same goal which the adopted transactions and operating rules intend to deliver
  • OPPORTUNITIES – Are there any identified areas for improvement of currently adopted transactions and their corresponding standards, code sets and identifiers?
  • OPPORTUNITIES – What, if any alternatives exist for improving efficiency and effectiveness of the business process for each of the transactions adopted and in use?
  • OPPORTUNITIES – Are there additional efficiency improvement opportunities for administrative and/or clinical processes of these transactions and strategies to measure impact? Would they be addressable via new or different standards?
  • OPPORTUNITIES – What alternatives exist to achieve similar or greater efficiency and effectiveness between trading partners at lower administrative cost?
  • CHANGES – Are there any changes that should be made to the current transaction standards, or the mandate to use them?

QUESTIONS ON OPERATING RULES APPLICABLE TO PANEL 2 (ELIGIBILITY), PANEL 6 (CLAIM STATUS) AND PANEL 7 (ERA/EFT)

  • [CAQH CORE] Outline the current mandated Operating Rules (Claims / Eligibility Status, EFT / ERA) and their intended benefits
  • [ALL] Overall, do the currently adopted operating rules meet the current (and near-term) business needs of the industry? Is the industry achieving the intended benefits from the operating rules? Please provide as much as possible any evidentiary information (qualitative or quantitative) to support your viewpoints
  • [ALL] Have there been any studies, measurement or analysis done that documents the extent to which the operating rules, as adopted and in use, have improved the efficiency and effectiveness of the business processes?
  • [ALL] Explain the perceived or actual adoption trend of each set of operating rules (by transaction, by industry sector – i.e., providers, health plans). Describe challenges and opportunities for broader adoption of these ORs by industry stakeholders
  • [ALL] Are there any identified areas for improvement of currently adopted operating rules?
  • [CAQH CORE] What will be the process for updating and publishing operating rules?
  • [ALL] What, if any alternatives exist for improving efficiency and effectiveness of the business process for each of the transactions for which operating rules have been adopted?
  • [ALL] Are there additional efficiency improvement opportunities for administrative and/or clinical processes of these transactions that can/should be addressed via operating rules, and strategies to measure impact?
  • [ALL] What alternatives exist to achieve greater efficiency and effectiveness between trading partners?
  • [ALL] Are there any changes that should be made to the current ORs or the mandate?
  • [CAQH CORE] What lessons learned from the adopted operating rules has or will be applied to the next set of proposed operating rules?

ADDITIONAL QUESTION FOR PANEL 1 – HEALTH PLAN ENROLLMENT/DISENROLLMENT AND HEALTH PLAN PREMIUM PAYMENT

  • What is the degree of usage of enrollment/disenrollment and premium payment transaction standard in health insurance exchanges?

ADDITIONAL QUESTION FOR PANEL 2 – HEALTH PLAN ELIGIBILITY, BENEFITS INQUIRY & RESPONSE (PART 1)

  • What is the degree of usage of non-batch transactions (i.e., web portals) for eligibility?

ADDITIONAL QUESTIONS FOR PANEL 3 – PRIOR AUTHORIZATION

  • What are the main reasons for non- or limited-usage of transaction?
  • What is the degree of usage of non-batch transactions (i.e., web portals) for prior authorization?

ADDITIONAL QUESTION FOR FOR PANEL 4 – HEALTH CARE CLAIM OR EQUIVALENT ENCOUNTER INFORMATION

  • What is the degree to which clean claims are being achieved?

ADDITIONAL QUESTIONS FOR PANEL 5 – COORDINATION OF BENEFITS

  • What is the status of coordination of benefits processes, opportunities for process improvement via operating rules?

ADDITIONAL QUESTION FOR PANEL 7 – HEALTH CARE PAYMENT, REMITTANCE ADVICE AND ELECTRONIC FUND TRANSFER

  • What is the status of use of CARC/RARC code sets?

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://ncvhs.hhs.gov