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HBMA Policies

National Committee on Vital and Health Statistics (NCVHS) received an oral and written testimony from Dave Nicholson, HBMA Government Relations Committee Member last month. The testimony covers various topics such as prior authorization and claims attachments. The efforts of the staff and members of HBMA Government Relations Committee are behind the preparation of this testimony. It appears that many other organizations also joined HBMA in this mission.

While offering specific recommendations on a number of areas, HBMA emphasized on the necessity of simplifying its administration policies. Some of the administrative policies are already in the process of simplification. Examples and real world anecdotes were cited when talked about these policies.

HBMA Testimony On Prior Authorization

The HBMA testimony covers two major areas: Prior Authorization (PA) and claims attachments. When it comes to PA, the recommendations made by HBMA received greater support from the committee members and the panel. Lot of questions about PA was asked during the Q&A session. The Q&A session was preceded by witness testimony presentations.

During the Q&A session, one committee member pointed out the insignificance of focusing on administrative simplification goals of the law. He noted this goal should have been discussed and achieved well in advance, pointing out the fact that HIPAA enactment marked its 20th anniversary.

Dave Nicholson also raised questions about the role of PA in the current scenario of Alternative Payment Models (APM) and Merit based Incentive Program (MIPS). Nicholson noted that both APM and MIPS depended too much on clinical decision support systems.

HBMA Testimony On Claims Attachments

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Questioning HBMA’s testimony on claims attachments, Nicholson said that it was too late and unacceptable to invest time and resources now on a very basic and simple thing like standard procedure of claim attachments. His statements were strong and convincing enough to make everybody develop a similar feeling. Although a majority of the members in the committee supported what Nicholson highlighted, they all said that it was necessary to develop a standard structure for both claim attachments and PA.

It is agreed that each organization in the healthcare industry should try to evolve their own standards and processes. At the end of the meeting, the committee said that organizations should be provided at least 2-3 years from now to implement their own standards for PA and claim attachments.

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