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ASC X12 Standards

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The accredited standards committee has been charged with developing the standards for EDI. The department of health and human services embraced the ASC X12 standards. The goal of EDI standards is to make seamless transfers of information between providers and healthcare plans and payers. ASX X12N 837 is a messaging standard that covers the electronic submission of healthcare claims (Sayles, 2013). The Pan American EDIFACT Board (PAEB) directs activities regionally for EDI message development, maintenance, and technical assessment. The United Nations Rules for Electronic Data Interchange for Administration, Commerce, and Transport (UN/EDIFACT) is a international guideline and agreed standard for electronic transfer of information mainly related to trade in goods and services. …show more content…

The following attributes apply to each data element: coded tag, title, plain text description, format, and year of insertion into the directory. The ASC X12 and the EDIFACT are very similar but the ASC X12 contains smaller messages while the EDIFACT contains fewer, more comprehensive messages. X12 was developed to meet the needs of the industry while EDIFACT has been slower to meet a practical use. EDIFACT, in 1994, had 43 standard messages and 14 in development while X12 had 37,000 US users and only 1% of businesses in the UK used EDIFACT. The challenges to implementation of EDI is that software and standards have been incompatible, there is a lack of sophisticated capabilities, and a lack of cross-industry standards. The future of EDI includes the agreement of ASC X12 to merge with EDIFACT. The number of users of EDI is expected to grow from 30,000 in 1995 to 300,000 by 2000 (Pupik,

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HIPAA has changed Healthcare Information in so many ways when it comes down to EDI. The system is designed to simplify electronic transactions and codes sets. The simplification of HIPAA was designed to show a consistency and operational improvements within the payer and the provider. In order to transfer healthcare information, it has to comply with the standards of HIPAA for that transaction.

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They should be hold accountable for any breach in protocols. • Present format for electronic documentation does not allow for comprehensive clinical documentation during follow-up visit. Efforts should be made to upgrade the electronic medical record system to the standard of that expected for a medical center and research institute. This is to allow for proper documentation according to the industrial standard, and easy retrieval of patient’s information for clinical research. There is a need to employ a clinical documentation improvement specialist (CDIS) in this

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E/M codes tell what was done in the office. Everything that the doctor or physician has done is documented, and coded. If a certain thing was not done then it should not be coded, and charged for that is considered fraud. Also everything that is done in the office must be documented, and coded using the E/M codes. If the E/M coding was done incorrectly the person would get in trouble for fraud, and not only that the office would have a bad reputation, and other insurance companies wouldn 't probably want to go through that office anymore.

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The healthcare industry generates a great amount of data every day, as a form of record keeping, patient care, compliance, and regulatory requirements. Just a decade ago, all this data was stored in the form of hard copy form, now it is rapidly transforming to digital data which is called EMR (Electronic Medical Record). The digitalization of the healthcare has not just reduced cost of care, but also improved quality of care due to the abundance data that organizations receive from the EMR to identify the flaws in their system. I work in the healthcare industry where improving quality of care is our primary goal. We use software called eCW , which is an integrated system.

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This rule adopts standards for eight electronic transactions and for code sets to be used in those transactions. It also contains requirements concerning the use of these standards by health plans, health care clearinghouses, and certain health care providers. The use of these standard transactions and code sets will improve the Medicare and Medicaid programs and other Federal health programs and private health programs, and the effectiveness and efficiency of the health care industry in general, by simplifying the administration of the system and enabling the efficient electronic transmission of certain health information. It implements some of the requirements of the Administrative Simplification subtitle of the Health Insurance.

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The article stated that business associates can offer DDE as an option to health plans and also DDE can be customized as well. Since DDE is an option, health plans can offer DDE to certain providers but DDE system must meet the requirements of HIPAA because of the information that is transmitted via electronic. However, some critical issues involved were sending as a transaction which is not DDE and health care plans are not to offer incentives to use the DDE system. Also, electronic data interchange (EDI) could not replace DDE because it is an option to providers but EDI has to used (Nachimsom,

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Health Information Exchange Providers across the U.S. are turning to the Health Information Exchange also known as HIE. HIE provides secure online access to patients charts among a network of providers, hospitals, clinics, doctor’s offices, and pharmacies who join in the exchange, so they can have timely electronic access to records their patients will allow them to share. For patients this means having their medical records available no matter where they go and for providers it means having instant access to life saving information when seconds count

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The focus of this paper will be geared toward the impact that the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and Health Information Technology have on the cost of health care. The regulations connected to HIPAA have an impact on cost through enforcement, noncompliance, and implementation. HIPAA is a vital tool in the protection of PHI of patients and the improvement of the Medicare and Medicaid programs (Cleverly). Trying to contribute to the improvement of Medicare alone can be a daunting and expensive task alone, but to add the addition of protecting the health records of millions of patients adds to the rising cost. Health Information Technology (HIT), aids in the enforcement of HIPAA and helps with billing patients accurately for services that they have received (Wizemann).

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The Health Information Trust Alliance (HITRUST) Common Security Framework (CSF) was established as a security program to regulate and safeguard health information in the United States due to security and privacy issues that healthcare organizations encountered. Furthermore, in order for it to be more cohesive and collective, the CSF combines federal and state regulations, standards, and incorporates frameworks such as the Health Insurance Portability and Accountability Act (HIPAA), National Institute of Standards and Technology (NIST), International Organization for Standardization (ISO), Control Objectives for Information and related Technology (COBIT), Payment Card Industry (PCI), Digital Security Standard (DSS) and the Cloud Security Alliance (CSA) Cloud Controls Matrix (Murphy, 2015; HITRUST Alliance, 2015a; HITRUST Alliance, 2015b; HITRUST, 2013). This was conceived into its security requirements and policies so that security risks could be evaluated and assessed within health organizations; and to institute and serve as a core baseline for these health organizations to be measured against. In addition, third-party vendors and business associates can employ the CSF to evaluate its products and its organization. As a result,

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Adding more parties to sharing data along with the time it takes to complete a cohesive DURSA agreement can be lengthy and costly. Another challenge of HIE is that HIEs can sometimes be viewed as providing duplicative information or solutions offering patient portals or patient related information directly to the consumer. Health information exchange has three key forms: directed exchange, query-based exchange, and consumer mediated exchange. Directed exchange is the “ability to send and receive secure information electronically between care providers to support coordinated care” Examples of patient information include ancillary test orders and results, patient care summaries, or consultation reports. The encrypted patient information is electronically sent securely between parties with an established relationship.

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