Matching: 20% Paper ID: 32995813 Words: 667

I.

Position Statement

a. There is currently an enormous amount of clerical work that drastically slow physician practices while trying to establish insurance verifications. New health care reform laws are slated to expedite these clerical burdens as well as reduce the amount of forms that are required.

II. Background

a. The enormous clerical burden on patients and health care providers in the current health care system has brought about the implementation of Section 1104 in the Patient Protection and Affordable Care Act (Health Care Reform) which will revamp the federal government's first attempt at taming administrative simplification with the passage of the Health Insurance Portability and Accountability Act, or HIPAA, in 1996. The new changes are slated to take affect no later than Oct. 1, 2012. b. Standards for existing HIPAA regulation, were created by the Council for Affordable Quality Health Care's Committee Compliance. However, most do not realize that these standards have been voluntary until now. The administration simplification in the Affordable Care Act deals with creating operating rules, which are defined in the law as "the necessary business rules and guidelines for the electronic exchange of information (Porter, 2010).

III. Applicable Federal Laws

a. The Patient Protection and Affordable Care Act will create substantial changes in the relationships between payers, providers (hospitals, physicians, and allied care practitioners), claims clearinghouses and banks (HIMSS, 2010)

b. The Health Insurance Portability and Accountability Act (HIPAA) requires that electronic transactions be transmitted using standard formats. On January 1, 2012, the current HIPAA standards will no longer be accepted. All entities transmitting and receiving electronic health care transactions must do so using the new 5010 version of the standards (American Academy of Family Physicians, 2011).

IV. Risk management Summary: Systems Perspective

a. Section 1104 will require the Department of Health and Human Services to develop operating rules for the electronic exchange of health information; they will also develop standards for electronic funds transactions and transfers, as well as develop the requirements for financial administrative transactions. b. Documentation of this compliance will be tightly controlled and mandated. c. A health plan will not be certified as being in compliance with standards that deal with electronic transactions until it is able to prove to HHS that it is fully complying with the regulation. The health plan will also have to provide documentation showing that the plan "has completed end-to-end testing with its partnering health care providers. d. The law will also give HHS the power to conduct periodic audits to ensure compliance. It also authorizes HHS to assess penalties to health plans that fail to meet certification requirements. Any imposed penalties will be on a perday basis that the plan remains outside of compliance. e. Health plans will face double the penalty if they knowingly provide inaccurate details to HHS.

V. Risk Management/Leadership Implications for Addressing Compliance

a. Increase budgets to allow for needed upgrades such as software b. Employee training of the new electronic system c. Maintain compliance with HIPAA and other regulatory standards

d. Ensure appropriate compliance by conducting self-audits within own facilities.

VI. Closing Remarks Overall, The Patient Protection and Affordable Care Act will provide tremendous changes between health care providers/facilities and payers. Communication will be key in making this a successful change as well as implementing necessary changes well in advance in order to ensure understanding of the new systems.

References: Bonvissuto, K. (2010). Administrative simplification not a completely impossible task. Managed Healthcare Executive, 20(8), 27-28. Retrieved from EBSCOhost. Healthcare Information and Management Systems Society (HIMSS). (2010). Administrative Simplification Implications of the Patient Protection and Affordable Care Act of 2010. Retrieved from the HIMSS (http://www.himss.org/content/files/HCRAS_Paper_201011.pdf) Kocher, R., Emanuel, E. J., & DeParle, N. M. (2010). The Affordable Care Act and the Future of Clinical Medicine: The Opportunities and Challenges. Annals of Internal Medicine, 153(8), 536-W.190. Retrieved from EBSCOhost. Porter, S. (2010). Health Care Reform Administrative Simplification Rules Could Lessen FPs' Administrative Burden. Retrieved from the American Academy of Family Physicians (http://www.aafp.org)