Three Months Following HIPAA Deadline, Payers Reportedly Rejecting More Physician Claims Due to Missing Data

January 15, 2004

According to a physician financial consulting group, 90 days after the Oct. 16, 2003 deadline, physician practices are seeing a growing pile of unpaid claims as payers reject more bills because they lack specific data elements. Many smaller practices cannot reportedly decipher what information is missing, nor can they correct and refile the claim within needed timeframes.

“It is a catch-22 for many smaller practices. It is difficult to know what they are doing wrong or how to fix it,” said John Thomas, CEO of MedSynergies, which provides financial consulting services to 300 physicians around the country and has issued a new white paper analyzing HIPAA technology issues.

“In the first months after the HIPAA transaction deadline, most payers were very flexible and processed claims that were technically noncompliant with their standards. But now many are tightening up and kicking back claims that do not include all the information they want in the correct format,” Thomas said.

The new HIPAA law standardized the electronic formats for filing medical claims, but it also reportedly allowed insurers to require specific data fields. Different payers are asking for different pieces of data. For example, some insurers require a patient’s date of birth while others want a hospital admission date.

Adding to the confusion, the contents of the new, standard 837 claim are reportedly almost impossible to understand unless one can read computer code. There are special characters used to delimit fields, segments and complete batches.

To help physicians and administrators understand the issues, MedSynergies has published a new white paper, “HIPAA Technology for Medical Groups: Using Electronic Transactions to Increase Revenue.” It is available free on the company’s Web site, . MedSynergies is a business service provider (BSP), integrating leading software programs and processes into the daily operations of medical practices. The company uses proprietary processes to identify and correct insurance denials and reveal payer rules that can be used to optimize reimbursement.

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