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Minnesota AUC Newsletter

November 2019

AUC Operations Committee regular quarterly meeting is 2-4 pm December 10, 2019

The AUC Committee of the Whole (aka Operations Committee), representing all of the approximately 40 member organizations of the AUC, will meet virtually 2-4 pm Tuesday, December 10. The meeting will include:

  • a review of a great deal of work by the Medical Code TAG in shortening, simplifying, and streamlining instructions and requirements for medical coding as part of the 837 Professional and 837 Institutional Minnesota Uniform Companion Guides;
  • a look back at AUC activities and accomplishments in 2019;
  • a look ahead with some planning and priority setting for 2020;
  • introductions to two nominees for AUC Operations 2020 co-chairs: Loni Wegman, Medica (payer representative) and Bonnie Hays, Hennepin Health (provider representative).

Additional information regarding the meeting, including Webex instructions, can be found on the AUC website.

New Eligibility (270-271) Best Practices Now Available

The AUC Eligibility Technical Advisory Group (TAG), recently developed three new best practices to address challenges and obtain greater information value in the exchange of the X12 v5010 270-271 Eligibility Inquiry and Response transaction. The three best practice documents are now available on the AUC Website and include:

  • Reporting Other or Additional Payer Information -- Provides reporting of other or additional payer information for a member when the information source has found the member to be active (active coverage response) and the other or additional payer information is known.
  • Multiple Service Type Inquiry/Response -- This Best Practice provides a mechanism for Information Receivers to request eligibility on multiple Service Types when needed to obtain information related to multiple Service Types. Information Sources would return an explicit response based on the Service Types requested by the Information Receiver.
  • Reporting Funding Type -- This Best Practice provides a mechanism for Information Sources to report the Funding Type of the member's group for an active response and applies to the 271 - Loop 2110C or 2110D, MSG segment.

The AUC Eligibility TAG continues to work through key challenges experienced by providers and payers with the 270-271. On December 18, 2019 the TAG will discuss which, if any, of the 10 best practices they have developed should possibly be adopted into the Minnesota Uniform Companion Guides. If you would like to learn more or participate in the meeting, information will be posted at /facilities/auc/tags/elig/info.htm.

National News

X12 announces public review period for two proposed v7030 Implementation Guides

The national standards setting organization, X12, recently announced a public review period November 15, 2019 – January 15, 2019 for the following proposed version 7030 Implementation Guides: the 277, Health Care Claim Acknowledgment (007030X330); and the 276/277, Health Care Claim Status Request and Response (007030X329). Following this review period, X12 will conduct a corresponding Informational Forum. The Informational Forum is the final opportunity for public discussion of the review comments and resulting revisions. The version 7030 Implementation Guides are anticipated to eventually supersede the current version 5010 Implementation Guides required pursuant to federal HIPAA transactions and code sets regulations.

The AUC previously submitted comments to X12 regarding an earlier version of the proposed v7030 277. There are no plans at this time for developing additional AUC comments. AUC members are encouraged to review the latest version of the proposed v7030 IGs and to submit comments individually if desired.

The draft implementation guides are available in an on-line forum at http://forums.x12.org. The draft guides are provided for public review and cannot be used for any other purpose without permission from X12. Reviewers may submit comments on the draft via the on-line forum. Instructions for reviewing the guides and submitting comments are also posted on the forums page.


Federal health care price transparency rules announced

As described below, on November 15, 2019 the Trump Administration announced two rules – one adopted and one proposed -- to increase health care price transparency.

Adopted rule: "Calendar Year (CY) 2020 Outpatient Prospective Payment System (OPPS) & Ambulatory Surgical Center (ASC) Price Transparency Requirements for Hospitals to Make Standard Charges Public Final Rule"

The adopted rule above requires hospitals to provide patients with clear, accessible information about their "standard charges" for the items and services they provide, including through the use of standardized data elements, making it easier to shop and compare across hospitals, as well as mitigating surprises.

The final rule will require hospitals to make their standard charges public in two ways beginning in 2021:

  • Comprehensive Machine-Readable File: Hospitals will be required to make public all hospital standard charges for all items and services on the Internet in a single data file that can be read by other computer systems. The file must include additional information such as common billing or accounting codes used by the hospital (such as Healthcare Common Procedure Coding System (HCPCS) codes) and a description of the item or service to provide common elements for consumers to compare standard charges from hospital to hospital.
  • Display of Shoppable Services in a Consumer-Friendly Manner: Hospitals will be required to make public payer-specific negotiated charges, the amount the hospital is willing to accept in cash from a patient for an item or service, and the minimum and maximum negotiated charges for 300 common shoppable services in a manner that is consumer-friendly and update the information at least annually. The rule defines "shoppable services" and requirements for the "consumer-friendly" file.

In order to ensure that hospitals comply with the requirements, the final rule provides CMS with new enforcement tools including monitoring, auditing, corrective action plans, and the ability to impose civil monetary penalties of $300 per day. The effective date of the rule is January 1, 2021.

Proposed rule: "Transparency in Coverage"

The proposed "Transparency in Coverage" rule would require most employer-based group health plans and health insurance issuers offering group and individual coverage to disclose price and cost-sharing information to participants, beneficiaries, and enrollees. If adopted, the proposed rule would require health plans to:

  • Give consumers real-time, personalized access to cost-sharing information, including an estimate of their cost-sharing liability for all covered healthcare items and services, through an online tool that most group health plans and health insurance issuers would be required to make available to all of their members, and in paper form, at the consumer’s request. This requirement is proposed to empower consumers to shop and compare costs between specific providers before receiving care.
  • Disclose on a public website their negotiated rates for in-network providers and allowed amounts paid for out-of-network providers. Making this information available to the public is intended to drive innovation, support informed, price-conscious decision-making, and promote competition in the healthcare industry.

As part of the federal rulemaking process, the proposed rule is now available for public comment through January 15, 2015.


CDC issues coding guidance for vaping-related health care encounters

With the dangers of vaping increasingly in the news and garnering broad attention, the CDC released guidance October 27 on ICD-10 coding for health care encounters related to e-cigarette, or vaping, product use associated lung injury (EVALI).

CDC stated that its coding guidance will be updated as needed as new clinical information becomes available. Proposals for new codes that are intended to address additional detail regarding use of e-cigarette, or vaping, products will be presented at the March 2020 ICD-10 Coordination and Maintenance Committee Meeting.

 
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