Connecting the HIPAA Dots | Article

healthcare outsourcingLooking for a HIPAA consultant to shepherd your healthcare organization through implementation of compliance projects? Look for an expert provider with actual experience in running transactions through a translator and mapping them to outside agencies – not one who primarily just trumpets knowledge of the new regulations.

Recognizing the value of working with consultants who are intricately knowledgeable of the peculiar nature of insurance and healthcare data transactions, University Hospitals Health System (UHHS), the renowned Cleveland, Ohio-based regional health system, chose Antares Management Solutions to develop and deploy HIPAA (Health Insurance Portability and Accountability Act) project management tools. The Web-based applications enable UHHS to track and document its complex HIPAA compliance activities and provide auditable proof to the government that the organization is on track with its compliance efforts.

Due to its extensive experience in the healthcare payer arena, Antares, a business process and IT outsourcing provider, “lives and breathes healthcare data and EDI (electronic data interchange) transactions daily,” says Bob Drake, Antares business solution provider. “It’s different from being an IT facilitator of data.”

From Knowledge Base to Solutions

Antares’ expertise in designing business-process-driven Web-based tools also came into play at UHHS. Alan Ogilbee, HIPAA project director at UHHS, reports the provider was flexible in meeting the health system’s requirements for adding the new functionality to its existing Web site and hospital environment.

“They brought a good deal of understanding in what we were trying to accomplish,” says Ogilbee. “With Antares, different team members have proven skills in design, development, database work, and so on. They bring to bear the best set of skills for all aspects of the project.”

UHHS first retained Antares for HIPAA consulting in the first quarter of 2002. “They wanted us to design tools to track their progress against the government deadlines,” recalls Drake. By second quarter 2002, the provider’s team had deployed the transaction and code set tracking application then began working on the privacy and security tracking application.

Providing a common repository for compliance activities and data, both tools allow managers and executives to log and track issues, identify potential trouble spots and solutions, track progress in implementing those solutions, track outside vendors and business partners involved in compliance efforts, and ensure the hospitals are meeting privacy compliance in a consistent manner.

The Web-based front end eliminates the need for UHHS to install and maintain another application layer at each hospital, thus making the solution more cost-effective.

The tools enable UHHS to track status and produce reports at a departmental or enterprise level for each hospital in its system. Their hospital system’s MS-SQL-based back end allows individuals to interrogate and isolate the deposited data for relevant issues. A CxO level query, for instance, might be: “What is the cost of this initiative?” At a project manager level, the query might be: “What do we need to do to be compliant in transactions with this vendor?” or “What is the progress of implementing the solution for this issue?”

The result is UHHS’ ability to proactively address HIPAA security and privacy issues before they have an adverse impact on the organization.

Both parties worked together to identify business needs and understand data flows and reporting requirements. Then Antares ensured end user buy-in by prototyping the application before doing the Web front-end screen designs. “They were very customer focused,” states Ogilbee. “They listened to our needs and were good at responding and communicating status.”

The Outsourcing Bridge

Business rules and transaction code sets at a healthcare provider organization differ from those of payer organizations. Similar to a translator between two foreign languages, the two transaction code sets require an automated translator.

John Frohlich, director of information systems development at Antares, says the outsourcing service provider has in-depth knowledge of how to interpret the HIPAA implementation guides (a complex challenge, considering some of the nine guides are 900+ pages long). “Interpreting the looping structures within those documents is part of our forte,” says Frohlich. “We understand the EDI translator, the healthcare business for patient billing and insurance claims and mapping those processes to the systems in outside agencies.”

When UHHS outsourced its HIPAA consulting and tracking tools, it was looking to an expert for help in connecting the dots among its HIPAA-compliance projects. But the hospital also sought to accomplish more than making systems interoperable and data transactions secure. It wanted to corral a business process and make it more efficient. An outsourcing provider’s expertise shortens and strengthens the bridge between the differing transaction code sets. By designing a menu-driven automated process for the workflow so that end users don’t need to figure out what to do, Antares made the process faster and cost-effective.

Doubletake on Price

Making and documenting the changes required by HIPAA is a major challenge for all sectors of the healthcare industry. Failure to comply with the regulations can result in fines of up to $250,000, so stakes are high. But so is the price of HIPAA compliance projects; and these costs have to be funded somehow. Leading healthcare provider organizations are already finding that outsourcing HIPAA consulting and implementation to experts results in faster reimbursements and other streamlined processes that improve cash flow…producing revenue to fund the government-mandated HIPAA initiatives.

Lessons from the Outsourcing Journal:

  • A HIPAA consultant should possess in-depth knowledge of how to interpret the HIPAA implementation guides, understand the EDI translator, the healthcare business for patient billing and insurance claims and mapping those processes to the systems in outside agencies.
  • Look for a HIPAA consultant with actual experience in running transactions through a translator and mapping them to outside agencies – not one who primarily just trumpets knowledge of the new regulations.
  • HIPAA tracking tools allow managers and executives to log and track issues, identify potential trouble spots and solutions, track progress in implementing those solutions and track outside vendors and business partners involved in compliance efforts.
  • Tracking tools proactively address HIPAA security and privacy issues before they have an adverse impact on the organization.


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