Worcester Medicine publishes “HPID: The confused birth, troubled life and untimely death of a federal regulation”

The Worcester District Medical Society published an article by Peter Martin in the March/April 2019 edition of its quarterly publication, Worcester Medicine. Below is an excerpt from the article.

Congress passes a law, and designates a federal agency charged with promulgating regulations and carry out Congress’ intent as expressed in the legislative language. The federal agency seeks input from concerned stakeholders through notice and comment rulemaking, issues proposed and final rules with prospective effect on the affected industry. Generally, this process works well, at least in the sense that – eventually – rules are issued with which the regulated industry must comply.

Why might this process not work well, and what recourse is available when that happens? A case in point might be the health plan identifier (HPID) originally required by section 262 of the HIPAA statute passed in 1996: the HPID was intended to aid providers and third-party payers with electronically engaging in a wide variety of HIPAA transactions – for example, patient eligibility determinations, claims billing and remittances of health care payments. By using these different numbers issued by different governmental or private organizations, the hope was that by instituting a national and unique identifier for each “health plan,” confusion could be avoided in such transactions.

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