NCVHS Letterhead

November 22, 2005

The Honorable Michael O. Leavitt
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201

Dear Secretary Leavitt:

As part of its responsibilities under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the National Committee on Vital and Health Statistics (NCVHS) is responsible for studying, selecting and recommending standards for electronic health claim attachments. We are pleased, therefore, to comment on the new claims attachment notice of proposed rulemaking (NPRM), which was published on September 23, 2005

NCVHS’ interest in the topic of claims attachments spans several years, including numerous hearings. Our recommendations most recently were provided in our letter on claims attachment dated March 5, 2004. We further evaluated the need for streamlined updating of transactions and code sets to keep pace with industry requirements and new use cases. This issue was addressed in the context of our recommendations on HIPAA-related topics, and included in Recommendation #2 in our letter on electronic prescribing, dated September 2, 2004.

We appreciate the efforts undertaken by the Centers for Medicare and Medicaid Services (CMS) in developing this claims attachment NPRM. We believe that use of electronic claims attachments will help decrease the administrative overhead associated with the clarification and adjudication of approximately one quarter of the healthcare claims submitted in the Nation today and help advance initiatives related to the development and adoption of electronic health records.

NCVHS supports the proposed standards for the electronic transmission of attachment information for the six types of claims attachments as set forth in the NPRM. We also recommend flexibility for adopting new claims attachments transmission and messaging standards and additional types of attachments. In particular, the NCVHS recommends the development of a streamlined process for adding new standards and attachments types and for modifying existing standards. The Committee urges the Department to investigate other ways that adoption of new versions could be accomplished without the need for the lengthy and cumbersome rulemaking process. On our part, we will continue to investigate improvements to the standards adoption and versioning processes.

We were interested to see that the development of the NPRM was informed by a small-scale pilot project with Empire Medicare Services, which focused on the “human decision variant” for sending text or converting data to text. We believe pilot testing is critical for both the “human decision variant” and the “computer decision variant,” in which data can be used in an automated fashion and read and understood by the computer. Because clearinghouses and vendors may not have experience with the LOINC code sets, we believe that pilots should include testing of the full range of LOINC along codes required by the Clinical and Laboratory Attachments, along with any other untested claims attachment types. NCVHS therefore recommends that pilot projects should be funded and conducted using both the computer and human variants for the full suite of claims attachments and attachment types that are proposed for adoption in this NPRM, as well as the other attachments that are under development, including home health care, durable medical equipment, periodontal services and children’s preventive health services. The Committee recommends that the Department partner with private industry to conduct additional pilot projects in the area of claims attachments.

Finally, the NCVHS is pleased that the Department has extended the comment period on this NPRM for 60 days. This will permit the industry to take the necessary time to comment on the business and technical implementation issues associated with the standards proposed in this NPRM.

The NCVHS wishes to thank you for the opportunity to submit these recommendations and comments.



Simon P. Cohn, M.D., M.P.H., Chairman
National Committee on Vital and Health Statistics

Cc: HHS Data Council Co-Chairs

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