January 2020

Minnesota AUC Newsletter

January 2020

AUC news you need to know - AUC Technical Advisory Group (TAG) updates

Much of the ongoing work of the AUC to reduce health care administrative costs and burdens occurs among several standing workgroups known as Technical Advisory Groups (TAGs). Each TAG typically helps address issues and questions related to the implementation and use of a particular X12 transaction for the exchange of health care administrative data. All TAG meetings are currently being conducted via Webex and are free and open to anyone interested in participating or listening in. For more information, check the AUC TAG webpage.

Eligibility TAG suggests incorporating best practices into rule

Over the past decade, the AUC has developed numerous best practices to clarify and help make HIPAA standard transactions more useful for the Minnesota community. These best practices are not mandatory but go hand in hand with rules known as Minnesota Uniform Companion Guides (MUCG) to help ensure more uniform, efficient exchanges of health care business (administrative) data. The Eligibility TAG alone has developed 10 such best practices.

In addition to developing best practices, the TAGs also conduct approximately annual reviews of the MUCG to ensure that they remain accurate, up-to-date, and valuable to end-users. During its annual review of the Eligibility (270/271) MUCG, the Eligibility TAG considered whether some eligibility best practices are being used broadly and frequently enough that they should be adopted as standard, mandatory practice as part of the MUCG. To inform its discussions, the TAG surveyed its members to learn which best practices were felt to be the best potential candidates to possibly include in the 270/271 MUCG.

Based on the survey results, the TAG identified two best practices in particular for further consideration to include in the MUCG: Reporting Restricted Recipient Program and Reporting Other or Additional Payor Information. The TAG plans to meet February 26 to vote on a recommendation to include the two best practices above in the 270/271 MUCG. As with AUC recommendations generally, if approved by the TAG, the recommendation will be forwarded to the AUC committee of the whole (Operations Committee) for review and a vote. Any recommendations for MUCG changes approved by the Operations Committee will then be forwarded to the Minnesota Department of Health for consideration as a possible MUCG rule change.

EOB/Remit TAG addresses common reporting of PMI, will be submitting RFI to X12 requesting interpretation of option

Yes, there are a lot of acronyms in the headline of this article, but they are all important.

The EOB/Remit TAG met January 21 to discuss and help address issues regarding current non-uniform reporting of a particular patient identification number on remittance advices (835 transactions). The efficient exchange of the number in question - a state ID number assigned to individual Medicaid beneficiaries known as the Person Master Index (PMI) number - is especially important to hospitals as part of reporting requirements for federal Medicaid Disproportionate Share Hospital (DSH) Payments. However, at this time several different approaches are used to report the PMI on remittance advices being returned to providers, often resulting in a cascade of additional administrative, financial, accounting, and auditing information follow-up or rework.

At the meeting, the TAG reviewed and discussed a suggested option for standard reporting of the PMI on the 835 transaction. However, during discussion questions were raised regarding whether the option was consistent with the instructions in the HIPAA-mandated v5010 X12 835 Implementation Guide. In order to address this question, the TAG plans to submit a formal “request for interpretation” (RFI) to the national standards setting organization, X12, for guidance on the issue. The TAG will then reconvene following X12’s response to further discuss the option for reporting PMIs.

In addition to addressing the PMI issue, the TAG also discussed key industry challenges and pain points regarding the effective, efficient use of the 835 transaction. It plans to focus on a number of key areas in the future, including: remittance advices not being exchanged electronically; financial balancing; clearinghouse best practices; and issues and questions associated with the 835 and electronic funds transfer (EFT).

Medical Code TAG and Claims DD TAG completing proposed revisions to 837P, 837I MUCG

As part of annual reviews of the Minnesota Uniform Companion Guide (MUCG) rules, the Medical Code TAG recently approved proposed major revisions to a section in the 837 Professional and 837 Institutional MUCG with medical coding instructions. The revisions were proposed to streamline and simplify the coding sections and to ensure that all information was current and accurate. The 837P and 837I MUCG, including the proposed revised medical coding sections, will be forwarded next to the Claims DD TAG for further review and any possible additional updates and revisions.

2020-2025 Federal Health IT Strategic Plan available for comment now through March 18, 2020

The Department of Health and Human Services, led by the Office of the National Coordinator for Health Information Technology (ONC), recently released the draft 2020-2025 Federal Health IT Strategic Plan for public comment. This plan, which was developed in collaboration with over 25 federal organizations, is intended to guide federal health information technology (IT) activities. Comments are due by March 18, 2020.

One of the plan's objectives of possible special relevance to the AUC is to "reduce regulatory and administrative burden on providers." Similarly, the plan identifies as a key opportunity in health care the continued movement to value-based care, which will require new levels of data and information exchange with likely implications for current health care administrative transactions and their relationship with clinical and other health data exchange.

Back to Minnesota AUC Newsletter Homepage

Updated Tuesday, 21-Apr-2020 16:01:29 CDT