When the new HIPAA transaction rules go into effect on Oct. 16, your staff must learn to speak a newly standardized coding language and become especially fluent in the codes that reflect problems with a transaction. Once your coders know what these problem codes mean, they'll know where to look on the records to identify and rectify the problem with your payers.

Adjusting reimbursement and payment claims
The 837 transactions are the ones you use to submit reimbursement claims to payers. The 835 transactions are for final payments, submitted from a payer to your facility (and your financial institution) as a record of payment information about the transfer of funds and payment processing information. Sometimes, you'll need to re-adjust these claims. Here are some of the claim-adjustment reason codes your business office must know to correct errors and receive the proper reimbursement owed to the facility.

Your staff should also learn to use remark codes to relay service-specific informational messages that cannot be expressed with a reason code. HIPAA requires Medicare contractors to use remark codes and messages whenever they apply. Although Medicare contractors may use their discretion to determine when certain remark codes apply to a payment decision, they must report any remark codes that do apply. Here are some crucial remark codes they'll need to know:

Claim-status inquiries
Your payers will use the 277 transaction codes to respond to your claim-status inquiries (which your coders send with 266 code sets). The 277 codes communicate information to you about the status of a claim - meaning whether it's been received, pended or paid. Your coders should pay particular attention to these codes reflecting problems with 837 claims:

The HIPAA home stretch
In preparation for Oct. 16, your facility needs to complete the following crucial steps. If you haven't already done so, you need to make their accomplishment a top priority. Doing so will save you a lot of grief in the near future.

• Educate your information system personnel on the collection of data, how it's entered and how it's transmitted. You may have to modify or upgrade some of your software. You may avail yourself of additional software geared toward smoother submission of HIPAA-compliant claims. Be aware that there may be additional fees involved.
• Evaluating your current method of electronic claim submissions. If you use a clearinghouse, it should already be HIPAA compliant and able to transmit all of your claims electronically in the required format. You should submit your claims to the clearinghouse in the HIPAA transaction format. The clearinghouse should serve as a secondary checkpoint for compliance and accuracy.
• If you submit your claims directly to the payer, you should already have begun preliminary transaction testing to determine the communication areas that still need improvement prior to Oct. 16. Doing so now may save you a lot of reimbursement headaches next month and beyond.

Remember that CMS will not pay Medicare claims submitted on paper once the HIPAA transaction rules take effect, except in limited instances (such as facilities with fewer than 10 full-time-equivalent employees and in cases where no method exists for filing electronic claims). CMS says the goal is to reduce the 13.9 percent of Medicare claims that are paper-based - 139 million of the approximately 1 billion payment requests it received during fiscal year 2002.

Although learning these codes can be a hassle, it's also an opportunity for your facility to improve the bottom line. The bright side is that your coders only have to learn them once. They'll no longer have to reference multiple lists of electronic message code sets when communicating with multiple health plans. Once your staff masters communication with these codes, they'll be able to get the correct information back to your payers smoothly and quickly.