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Health reform vs. the 1990s

By Jay MacDonald ·
Friday, August 10, 2012
Posted: 10 am ET

If "The Wizard of Oz" taught us nothing else, it's that the real magic takes place behind the scenes. And it was precisely behind the scenes this week that health care reform pulled off another milestone.

You need not know exactly how the magic works, only that it is designed to save you money on your health insurance for years to come.

Not to peek overly long behind the screen, but a little background helps one appreciate the hard work of the largely unrecognized health reform geeks who've been slaving for years to bring America's health care administrative infrastructure into the 21st century.

Back in 1996, Congress recognized the need to computerize how hospitals, physicians, health care providers and insurance companies communicate with each other when it passed the Health Insurance Portability and Accountability Act, or HIPAA. Sure, computers are ubiquitous in our daily lives now. But you'd be shocked at how many administrators still fax forests of paperwork back and forth at a ridiculous cost to you, me and the planet, or simply can't communicate electronically with each other for want of a common framework.

Enter the Affordable Care Act of 2010. It requires Health and Human Services to streamline and standardize health care administrative communications over a five-year period.

In July 2011, HHS issued its first set of regulations to speed eligibility and claim status interactions. Last January, the feds laid out phase two: standards for claim payments made by Electronic Funds Transfer, or EFT, as well as electronic remittance advice, or ERA, an electronic version of a payment explanation.

On Tuesday, HHS formally adopted those EFT and ERA operating rules, which it estimates will save the health care industry, particularly physician practices, between $300 million and $3.3 billion over the next decade. The various players have until Jan. 1, 2014 to bring their back offices into compliance.

In the coming months, HHS plans to introduce standards for a unique identifier for health plans and claims attachments, as well as require participating health plans to certify compliance with this new, improved version of HIPAA brought about by health care reform.

The electronic records initiative doesn't garner a lot of attention, much less recognition, in this gale-force election year.

But it should. Because if there's one thing we can all agree upon in these fractious times, it's that we can't afford to leave health care administration technologically stuck in the Nineties.

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August 22, 2012 at 3:38 am

A lot. More today than a year ago.Because of Obamacare, no company in America ofrefs stand alone children's health insurance.Why? Obamacare dictates that it is guaranteed issue, without rate ups, regardless of health. Therefore, there is no reason to purchase it until there is a claim needing to be paid.That's not health insurance. That's a confiscatory tax on health insurance companies. Fortunately, they aren't slaves yet, so they exercised the F U clause in the contract with the purple bellies from Washington and just refused to do business where they are guaranteed to lose money.How do you fix the problem of un- and under-insured? By making health insurance affordable.How do you make it affordable? By removing ALL government mandates, loser pays tort reform, encouraging competition between providers (enforce existing anti-trust laws), eliminate the AMA monopoly on billing codes, and eliminate the connection between employment and health insurance.Do these things and we'll see health insurance cost less than auto insurance. More people will be covered, more people will be healthy.

August 13, 2012 at 9:31 am

Steven believes this interferes with the "free markets" common but vague argument that opposes health care reform AND banking controls. The problem with his premise is that my health is not and should never be a "market". It is my life, and as long as for profit corporations that have nothing more than their stockholders for motivation are in control of if and how I get medical care, I will always lose.
My health should not be for sale on the "free market", and I proposed that we throw the whole insurance system out. Our health as a nation has deteriorated as a result.

August 10, 2012 at 11:11 am

YES, when it comes to government INTERFERENCE in the free market, we DO need to know how it works, because what they SAY it is designed to do is a LIE.

"Because if there's one thing we can all agree upon in these fractious times"

There ISN'T, never has been, never will be, and SHOULDN'T be. I contend that government attempts to fix aledged problems are the primary CAUSE of the vast majority of actual problems.