KEYWORDS:
Reimbursement, X12, Electronic Medicare billing
BACKGROUND:
Health units in Louisiana's 54 local parishes used a "roster billing" method to complete paper forms for flu and pneumonia shots for Medicare patients. These forms were collected, aggregated, verified, collated and then submitted to a health care clearinghouse for keying and electronic submission to Medicare. Creation of an X12 export from the state immunization registry has allowed the registry to submit this data to Medicare in an electronic form, eliminating paper forms and unnecessary staff work. More importantly, it has reduced the former 3-6 month delay for reimbursement, and electronic fund transfers (EFT) are made to the immunization program within one week of submission. Before the process was implemented, a validation study was completed with each parish health unit to verify that paper data submissions could be matched to electronic data in the registry. The PHU had to meet a high standard for accuracy and completeness before elimination of the paper forms was approved.
OBJECTIVE:
1.) Describe the process for using the X12 format for reimbursement.
2.) Identify the lessons learned and barriers addressed
3.) Describe the process and the benefits of using X12
4.) Describe the data validation method and results.
METHOD:
Technical review of the Medicare X12 billing standard, development and testing of the export, validation and implementation of the functionality. Development of paper and electronic data validation process, review and evaluation of data.
RESULT:
Few parish health units did not initially meet the data quality standard. Those that did not were provided specific intervention and were highly motivated to improve data entry. Electronic reimbursement significantly improves the timeliness and efficiency of claims payment from Medicare.
CONCLUSION:
X12 is a HIPAA mandated standard for billing. Registries that wish to implement electronic billing must become proficient in this standard. Quicker payment and fewer forms are among its many benefits.
LEARNING OBJECTIVES:
1.) Become familiar with the X12 billing format
2.) Describe the benefits in decreased staff involvement to going all electronic
Back to Digging For Data -- Finding Usefulness From Billing Transactions
Back to The 2003 Immunization Registry Conference (October 27-29, 2003)