White Paper: HIPAA 5010 A Second Chance For The Industry To Implement Transaction Standards To Reduce Costs And Increase Efficiency

The healthcare industry stands at familiar crossroads as it prepares to implement new electronic transaction standards. Less than a decade ago, the industry stood in a similar position with the transaction standards mandated by the Federal Health Insurance Portability and Accountability Act (HIPAA). Today, as back then, the industry must choose a path. One path leads to full implementation of the standards, resulting in a single set of transactions used throughout the industry. The other path focuses on "adapting" the transaction standards to work with existing systems.

The latter approach is what the majority of payors chose to pursue during the first HIPAA implementation. It's an expedient approach that minimizes implementation costs by relying on workarounds and companion guides, but it results in each payor using its own proprietary variation of the standard. In the end, what was intended to create savings through a single, industry-wide standard has resulted in hundreds — perhaps thousands — of proprietary adaptations that have added additional costs and complexities into the nation's healthcare system.

Now, the industry has a second chance to fully implement new transaction standards. It's an opportunity to substantially reduce administrative costs and increase efficiency. In fact, the net financial benefits to the industry could reach $33.8B, according to the Department of Health and Human Services (HHS).1 However, realizing these benefits is dependent on fully implementing the standard and increasing provider usage of electronic transactions.