Hospitals Must Cut Administrative Tasks, Red Tape, AHA Says

Group supports HIPAA rules

In a new report, the American Hospital Association (AHA) states that centers must cut down on paperwork and other bureaucratic exercises that can cause health care costs to mount. The group suggests that hospitals convert many of these processes to an electronic format, particularly with regard to verification of benefits eligibility and other processes linked to faster reimbursement for care.

“It is estimated that the U.S. health care delivery system spends 15 to 32 percent of each health care dollar on the types of administrative costs that would be streamlined through the adoption of the HIPAA [Health Insurance Portability and Accountability Act] transactions standards and operating rules processes,” the report says.

Wider use of the HIPAA standards can support more information sharing between health plans and providers, a key benefit for organizations participating in emerging care models, such as payment bundling and accountable care organizations (ACOs), according to the AHA. Greater dialogue between providers and health plans also can help promote the sharing of meaningful data while simultaneously reducing the paperwork burden and promoting greater efficiency.

HIPAA required the Department of Health and Human Services (HHS) to develop and implement a framework for electronic health care transactions, code sets, identifiers and other administrative aspects related to the delivery and coverage of health care services. Over 17 years, the field has developed a common set of standards for the submission of claims, eligibility and claim status inquiries, and other transactions, including the payment of premiums, eligibility and benefit verification, and electronic claims.

According to the AHA, the administrative simplification promoted by HIPAA:

·         Reduces the paperwork burden for providers and patients

·         Prepares the field for health reform changes in reimbursement by better integrating financial and clinical data

·         Helps patients learn about their financial obligations up front

The report concludes: “Administrative simplification facilitates the smart use of information technology to reduce costs and increase efficiency. Achieving these goals will require cultural, operational and policy changes. It also offers opportunities to work collaboratively across the field to achieve mutual benefits for all stakeholders—providers, health plans, vendors, and patients.”

Sources: AHA TrendWatch; January 2016; and FierceHealthFinance; January 28, 2016.