Electronic filing rule could delay payments

Physician groups foresee problems with implementation of this latest HIPAA requirement and are pushing for contingency plans.

By Joel B. Finkelstein, AMNews staff. July 21, 2003.

Washington -- Federal electronic standards are headed for a "train wreck" that could mean delayed reimbursement, and physicians should prepare for the worst, according to health care consultants and medical groups.

"This industry-level convergence of unachievable goals and unanticipated consequences threatens to shake the fiscal foundation of the health care industry, which undergirds one-seventh of the U.S. economy," Martin Jensen wrote in an analysis of the coming standards. Jensen is a consultant with the APTi Group Inc., a project management company in Tulsa, Okla.

Physicians and others covered by the standards must be in compliance by Oct. 16. The Dept. of Health and Human Services has offered little guidance for implementing this next hurdle mandated by the Health Insurance Portability and Accountability Act, Jensen said.

This has left physicians unclear about their roles in the implementation process, said Bud Meadows, vice president of sales at Medical Manager Health Systems, part of WebMD's claims clearinghouse services.

Consequently, physicians have had to wait for vendors and health plans to develop implementation plans, a process that was delayed by the relatively late publishing of final rules, said Robert Tennant, a health informatics specialist at the Medical Group Management Assn.

Jensen and the others are worried that confusion over the rules will drive many physicians to convert wholesale back to paper claims, clogging up the reimbursement process.