HIPAA STANDARDS: Dual Code Sets Are Acceptable for Reporting Medical Procedures
Abstract
Medical care involves the provision of a myriad of health-related services, from the diagnosis of medical condition to its treatment. A means to consistently classify, define, and distinguish among these and other health-related services is critical for reimbursing providers and analyzing health care utilization, outcomes, and cost. Codes serve this role by assigning each distinct service a unique identifier. Health care providers, such as hospitals and physicians, report medical conditions and the health-related services they have provided to patients on medical records, which are in turn transcribed into corresponding codes by coding professionals. These codes are then reported on claims forms and submitted to both public and private payers for payment. In addition to their use in these financial and administrative transactions, codes facilitate the analysis of data that are used in motoring resource utilization and cost; measuring the quality, safety, and efficacy of care; analyzing outcomes of treatment options; and identifying fraud and abuse. Until recently, there was wide variability in requirements for coding health-related services, such as procedures, diagnoses, medical devices, supplies, and prescription drugs. For example, coding requirements could vary from payer to payer, making the filing of claims with multiple payers administratively burdensome for providers. In addition, this wide variability in coding made it difficult to electronically transmit standardized health-related information and compromised the reliability of health-related data. In enacting the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the Congress sought to simplify data reporting and claims processing requirements across all providers and payers and facilitate the electronic transmission of health-related information.1
Document Details
- Document Type
- Technical Report
- Publication Date
- Aug 01, 2002
- Accession Number
- ADA404803
Entities
Organizations
- United States Government Accountability Office