Leading Healthcare Billing Firm, Professional Management, Inc. Hosts CMS for a Real-World Discussion on the Successes and Failures of the HIPAA Transactions Standards

Share Article

Baltimore-Based Healthcare Billing Firm, PMI, Hosts CMS for Case Study in " Day in the Life of a Claim"

PMI, a leading Baltimore-based healthcare billing company for over 48 years and founding member of their trade association HBMA (Healthcare Business and Management Association), offered to host an informal meeting between key members of the National Standard Group and PMI.

CMS (Centers of Medicare and Medicaid Services) wanted to visit a billing company and a medical practice in the Baltimore area to see “a day in the life of a claim”. Recently, Ten CMS staff members from the NSG (National Standards Group), the group within CMS that writes, oversees and enforces HIPAA administrative simplification standards, led by Division Director Shana Olshan, visited PMI.

The National Standards Group (NSG) is a division of CMS’s Office of Enterprise Information, which has oversight/enforcement responsibility for HIPAA Administrative Simplification, not only for Medicare, but commercial insurers and Medicaid as well.

PMI was asked to provide an afternoon for discussion with NSG to review real-world case studies on “the day in the life of a claim”. As a local Baltimore revenue cycle management company, PMI offers 48 years of experience, expertise and insight into the medical billing process.

Much of the discussion centered around the usability of the various claims transaction operating rules, such as the utility of the 837/835; how, or if, the offices used the electronic claims status function or the electronic eligibility inquiry functions. Did plans offer them this option, and if they didn’t, why had neither group ever submitted a HIPAA complaint?

The answers were illuminating for the CMS staff. The concept of developing internal “work arounds” seemed shocking to them. It was surprising the number of internal changes made to ensure claims are processed and paid.

Following the afternoon discussions, CMS staff left feeling far more educated about the day in the life of a claim. Giving them a clearer understanding of what is involved and the complexity of the billing process.

In a follow-up email from the CMS staff, they said, “on a scale of 1 –10, this was a 100!” In fact, a critical CMS staffer in attendance recommended that ALL CMS staff be required to hear this presentation.

About Professional Management, Inc. (PMI)
Founded in 1968, Professional Management, Inc. is an industry leader specializing in revenue cycle management, accounts receivable management services, and consulting services for physicians, physician groups, and hospitals. For more information about PMI: http://www.pmi-web.com

Share article on social media or email:

View article via:

Pdf Print

Contact Author

Laura Price
Laura Price PR
+1 (215) 939-1508
Email >

Dave Nicholson
Visit website