New Health Care Electronic Transactions Standards

The Health Insurance Portability and Accountability Act of 1996 (HIPAA)
requires the Secretary of the Department of Health and Human Services
(HHS) to adopt standards that covered entities (health plans, health
care clearinghouses, and certain health care providers) must use when
electronically conducting certain health care administrative transactions,
such as claims, remittance, eligibility, and claims status requests
and responses.
Over 99 percent of Medicare Part A claims and over 96 percent of
Medicare Part B claims transactions are received electronically. The
current versions of the standards (the Accredited Standards Committee
X12 Version 4010/4010A1 for health care transactions and the National
Council for Prescription Drug Programs [NCPDP] Version 5.1 for
pharmacy transactions) used in these health care transactions lack certain
functionality required by the health care industry. Therefore, it is necessary
for providers to prepare for new standards in order to continue submitting
claims electronically. This fact sheet provides basic information about the
new transactions standards for the following versions adopted by HHS:
ASC X12 Version 5010, and NCPDP Versions D.0 and 3.0.
What Regulatory Requirements are Responsible for the
Transactions Standards?
• HIPAA mandated that the health
c a r e i n d u s t r y u s e s t a n d a r d
formats for electronic claims and
claims-related transactions.
• The Transactions and Code Sets Final
Rule, published on August 17, 2000,
adopted the International Classification
of Diseases, 9th Revision, Clinical
Modification (ICD-9-CM) as a HIPAA
standard for transactions.

Performance Reviews: Making Them Fair, Pleasant and Successful

Performance reviews are a key factor in motivating an individual as well as an office. A recent Medical Office Manager article suggests a few rules to live by when giving effective performance reviews.

Rule #1 Cover the Entire Review Period. The last few weeks are what you remember, but important things regarding this staff member probably happened earlier in the year as well. In order for you to cover the entire review period, keep a log of each staff member’s performance. Jot down ongoing notes regarding compliments and complaints for your staff. Be sure to have your staff do a self-assessment too.

Rule #2 Don’t Use Personal Terms. Demeaning labels and personal terms such as lazy, rude, or inconsiderate have no place in the review process. There are better ways to make the point.

Rule #3 Write and Say the Same Things. Some managers are conflict adverse and only write negative items in the review keeping the face-to-face meeting light. If it’s important enough to write about, it should be brought up in the meeting as well. This gives everyone a chance to talk through the item and make workable changes.

Rule #4 Give the Review Enough Time. A good review should last about 45 minutes.

A suggested review outline is:
Goals: Review the completed ones and set new goals.
The Job Description: Evaluate the performances in each duty and responsibility.
Core Values: Evaluate the staff member’s soft skills such as ability to communicate, be a team player, and take criticism.
Career Development: Discuss strengths and weaknesses and how to enhance or improve them.
A Summary: An example is “I think you had a good year and have done well with A, B, C. I’d like you to focus on X, Y, Z.
The Staff Member’s Comments: Wrap up by asking for your staff member’s comments.