CMS To Explore New Electronic Transaction Standards

Posted on by Frank J. Rosello

Although new HIPAA electronic transaction standards have been put on the backburner, the Centers for Medicare & Medicaid Services (CMS) has begun the process of mapping out how those new standards will function.

Part of that process is to figure out what the impact of moving to new standards will be on the healthcare industry, and to do that it has awarded a contract to revenue and payment cycle management company Emdeon.

The Nashville, Tenn.-based company will create an analytical methodology to define the processes and tools needed to move electronic transaction standards to a new version.

According to CMS, the intent of the project is to greatly reduce the likelihood of technical issues going undetected until after the standards are adopted and to eliminate the negative impacts such issues would have on the healthcare industry.

Debbie Meisner, vice president, regulatory strategy at Emdeon, said the testing program is not being driven by the health reform law, but is instead a result of industry testimonies on the need to test the standards before they are adopted. Those in the industry expressed a desire to avoid delays in implementation due to a need for errata and to avoid issues around the business impacts of the standards. Meisner said the program does not address EFT-only transactions.

“The intent is to use the 6020 version of the HIPAA transactions as a pilot for testing new versions of the HIPAA transactions and provide feedback to CMS on the results,” Meisner said. “The Department of Health and Human Services is looking to address the concerns of the industry with regards to adopting standards that have not been tested.”

The pilot does not address electronic funds transfers (EFTs), said Meisner, nor operating rules, added Amanda Woodhead, corporate communications manager at Emdeon. Woodhead said Emdeon’s original solicitation did include operating rules, but was ultimately separated into two solicitations.

Emdeon will approach the testing program in three phases. In phase one, Emdeon will perform extensive analysis on the changes that have been introduced in the new version. This will include gap analysis reports, analytics where appropriate and recommendations on any challenges that the industry will face as a result of the changes.

The second phase will be the development of the translations between the current 5010 version and 6020, followed by testing of the translations to determine if there are any outstanding issues that will need to be addressed. The final phase will be evaluating the lessons learned from the pilot and providing recommendations for testing new versions in the future.

Emdeon said its project with CMS is expected to be complete by September 2013.

Article written by Rodney J. Moore

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