WebMD Releases White Paper Urging HHS To Adopt 'Rational Roll-Out Plan' For HIPAA

ELMWOOD PARK, NJ – July 19, 2004 – WebMD Corporation today released a white paper on the implementation of the Health Insurance Portability and Accountability Act (HIPAA) that concludes the law's Administrative Simplification provisions are increasing complexity and costs for healthcare providers and payers across the country. The white paper, which is the result of WebMD's analysis of HIPAA implementation nationwide, identifies concrete steps that the US Department of Health and Human Services (HHS) can take to steer the implementation back on course, through a "rational roll-out plan." The paper, entitled "HIPAA Implementation: The Case for a Rational Roll-Out Plan," explores how the law – as implemented – has not advanced HIPAA's promise of simplification, standardization and reduced cost, but rather has had the reverse effect. It states that Administrative Simplification is at risk for three reasons: 1) a lack of uniformity in implementing the standards; 2) a failure by the healthcare industry to implement all of the standard transactions to enable a "two-way street" for information exchange between payers and physicians; and, 3) confusing and unnecessary data content requirements.

"HIPAA has achieved only a fraction of its potential because of the demands of the law and the ways in which it has been interpreted and implemented," said Roger Holstein, CEO, WebMD Corporation. "Our hope is that this white paper will encourage all parties who share a stake in HIPAA's successful implementation to begin a dialogue in search of practical real-world solutions that will help bring about industry-wide success in achieving HIPAA's promise."

The white paper reports that although health care claims are widely exchanged in the HIPAA standard format, the other standard transactions lag far behind. WebMD processes more than 3 billion transactions on an annual basis for 300,000 physicians, hospitals, dentists, labs and pharmacies, submitting to more than 1,500 payer connections. Although fewer than 19% of the medical claims received are in HIPAA format, 70% of the medical claims and 80% of all transactions going out to payers are in HIPAA format. Only 3.1% of the payers to which WebMD transmits claims are engaging in all of the HIPAA standard eligibility, claims status, and remittance advice transactions through WebMD.

Furthermore, the paper explores how the lack of acknowledgement of receipt of information provided from a healthcare provider to a payer has emerged as an ongoing provider issue. To the extent that payers acknowledge receipt of a claim at all, the format is not uniform, and as a result, providers are not able to efficiently accept, process and respond to the information included in the acknowledgment.

The White Paper urges the US Department of Health and Human Services (HHS), and the agency's Centers for Medicaid and Medicare Services (CMS), to take action through a series of course corrections, including:

• Continuing the contingency period under which trading partners are operating under contingency plans.
  
• Defining a HIPAA standard claims transaction to include only that content necessary for the adjudication of the claim and enforcing the content requirements only as a cap on what may be contained in a covered transaction.
  
• Coordinating a rational, industry-wide roll-out that promotes the exchange of all HIPAA standard transactions, not just claims.

The white paper suggests that CMS' actions are vital to ensuring that the HIPAA objectives of cost savings and increased efficiency are achieved and that success or failure here will have significant implications for the country's National Health Information Infrastructure.

Read the white paper (PDF).

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