HIMSS18: HATA leaders on simplifying PA and the rumblings about blockchain

Several years after being launched, the Healthcare Administrative Technology Association (HATA) feels it’s made progress on priorities like electronic funds transfer (EFT) and electronic remittance advice (ERA), with more work to be done on addressing prior authorization (PA) headaches through the practice management systems (PMS) industry it represents.

Ahead of HIMSS18 in Las Vegas, HATA executive director Tim McMullen and external affairs director Sherri Dumford, MBA, spoke with HealthExec on the group’s priorities in the near future, including whether blockchain can be utilized among PMS vendors.

HealthExec: Where do you see opportunities for movement in regulations at ONC and CMS which would affect your members this year?

Tim McMullen: Over at CMS, its National Committee on Vital and Health Statistics, NCVHS, is working on what it calls the “Predictability Roadmap,” so as they are working on writing these regulations, they do it in a manner that isn’t too cumbersome on providers and the technology they use. They’ve been talking about it for years and it came at a time when Meaningful Use and ICD-10 and all these standards came down on providers and their vendors. We’re actively working on making recommendations on that NCVHS roadmap.

I know when HATA first launched, promoting the adoption of ERA and EFT was a major priority. Where does that stand in 2018?

McMullen: Right now, we have resources on our website on ERA and EFT. When that first went up, we had about 11,000 hits on that. The EFT part is not the really the issue, that’s upon the providers getting together with their banks to make that happen. It’s really the ERA and the reassociation of the bank accounts. Education has been our focus lately.

Sherri Dumford, MBA: From an industry standpoint, EFT is a relatively simple thing to get established for a provider. On ERA, there are still some issues from the payer in terms of the electronic application and how they may handle adjustments and refunds. Those are some of the nuances HATA hopes to work through with the commercial payers. For providers, it’s very time-consuming to reconcile the EFT with the ERA because it’s not always a one-for-one match. You may get an EFT for $35, but it might have come into an ERA that’s $170.

HATA has made simplifying the prior authorization (PA) process a priority more recently, participating in a multi-stakeholder talk at last year’s HIMSS. Have practices seen tangible progress since then?

Dumford: The subject of PA has been around for a long time, but the work has been done in silos. One of the areas of progression this year—and this really came about after that HIMSS panel—is these siloed efforts are now being driven by what’s called the Prior Authorization Council. While they’re not doing much detail work yet, they are trying to corral everybody’s efforts to make a bigger impact. At HATA, we’re trying to bring real-life examples to commercial payers on why it’s not working from the provider and the PMS vendor perspective. It goes back to, not necessarily the transaction doesn’t work, it’s the operational workflow that’s a challenge. All payers do it different, so there are lots of details on what you might need to know for United Healthcare versus Aetna versus Cigna versus Humana.

What new capabilities do you expect from PMS vendors in the future?

McMullen: I think capabilities on simplifying PA are going to be fine-tuned and more widely-adopted technology as we get some standards around the attachments from CMS. Making it more transparent and automated will be a huge leap.

From our membership’s standpoint, we’ve been having a lot of requests on blockchain technology. That is something on the horizon. We’ve also been hearing a little bit on artificial intelligence (AI), especially on PA transactions, on how that technology, which is still way out there and how it could be possibly used by PMS vendors.

What kind of specific questions are you getting about blockchain?

McMullen: The question we get is “How can I use this? How does this fit into healthcare?” It’s like you’ve given me a hammer, but you haven’t told me what to do with it. That’s what our folks are trying to figure out.