Industry moves on HIPAA standards, but transition will be slow

Numerous interpretations of the guidelines make uniformity in electronic transmissions elusive, but work is under way to meet that goal -- likely still a decade away.

By Joel B. Finkelstein, AMNews staff. Nov. 15, 2004.

Washington -- Physicians may view the federal electronic data interchange standards as a broken promise. But private groups are working together to put the simplification back in this part of the HIPAA administrative simplification provisions.

That's good news, but it is likely to take at least a decade or two for functional standardization to take hold, according to experts.

"It's a real mess," said Kepa Zubeldia, MD, speaking of the current status of compliance with this portion of the Health Insurance Portability and Accountability Act. Enormous variation still exists in interpreting the rule's requirements.

Some experts say that the Centers for Medicare & Medicaid Services allowed too much wiggle room in how companies interpret the transaction and code set rule, but that flexibility is by design, said Karen Trudel, deputy director of CMS' Office of HIPAA Standards.

The intent of the rule was never to impose standards on the industry, but to give payers, clearinghouses and physicians' offices the flexibility to comply with HIPAA while maintaining the unique needs of their business practices, she said.

However, that variability has made things more complicated, rather than simpler when it comes to sending claims and other electronic forms, said Dr. Zubeldia.

HIPAA implementation has seen a rise in companion guides -- manuals published by payers and clearinghouses that define their own interpretations of the HIPAA standards and unique requirements for filling out claims and other electronic forms. Before HIPAA, they numbered around 400, and now there are more than a thousand.