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Guest Columnists

East to West, State Medicaid Officials Echo Discontent:
Admin. Simp. Proves No Simple Task

Sydney Smith
CRE Website Reporter

May 21, 2001

In a time crunch pushed by The Department of Health and Human Services, State Medicaid Officials place hope in a CRE petition easing up HIPAA deadlines for Admin. Simp. Complaints of unreasonable time lines and incomplete methods of practice sprawl over a nation of states conforming to national standardization.

"This is actually not just Medicaid," says Alan Shugart, Medicaid Director of Systems and Operations in Maryland. "This is everyone. Your private health insurance is covered by this." Shugart points out other providers like Medicare, Blue Cross and Blue Shield and "all your commercial insurers."

By itself, rolling these entities onto one universal system isn't the gripe. It's how and when HHS wants it done. Deadlines to complete standardization loom in October 2002 and this only earmarks part of a series of changes that make the process whole.

"We've always had a lot of antiquated ways of doing business," says Montana Representative of Medicaid Directors, Sally Klein. "I think that standardizing is a wonderful opportunity and an opportunity to become economical about processing claims," she says.

"The less types of hoops that providers have to go through, the easier it's going to be for them to bill and get paid." Some hospitals and providers bill over a hundred different numbers, Klein says. So, HIPAA should eliminate some confusion.

However, Klein's state, compared to others, may be technologically challenged. "In Montana, it'll be a long time before they get onboard with electronic transmissions," she says. "If payers move too quickly and force issues," that will negatively impact those doctor's offices unable to afford the technology.

"So, we go in and change our systems to do these electronic transactions and, in a year from now, we have to go in and change them again." Shugart adds that even the first set of adjustments pose challenges to smaller towns across the country. "Each software vendor that puts in the doctor's practice management system has to be ready to go to this." Then additionally, "people will be doing systems work on incomplete systems."

So, open your mouth and say ugh. "The ramifications get down to the doctor's office," he says. "It is going to be extremely difficult to try to implement the entire Administrative Simplification portion when, right now, the only thing you have up is Transactions and Code Sets."

The passing of these two components with no regard to National Payer and National Provider could result in consequences for the payment to the provider. Shugart suggests this works against the fundamental principals of Administrative Simplification. "To the extent that providers aren't getting paid, then you may have an impact on recipients."

Jane Alm, HIPAA Implementation Coordinator for Medicaid in Oregon, concurs that staggered implementation and limited time remains the touchstone for worries on the West Coast. "That seems to be what I keep hearing, anyway, as the state's most difficult thing to accommodate," she says. "That's a tremendously tight time frame."

Klein describes Admin. Simp. as "a moving target" and, with regard to the power points outlined in the CRE's Petition, she hopes "HHS is giving them serious consideration." She says, "if we had all the rules written" and a "period of time until we could get it implemented, then I think we'd all be playing in the same sand box."

However, nobody's ready to take toys and go home. Shugart says his state is committed to Administrative Simplification. He's "just inclined with adequate testing time built into it. I would rather have all the rules out there."

Sydney Smith was previously a reporter with Channel 11 News (Toledo, Ohio)