05 Aug 2009

Sample Essay: Major Health Care Trend Occuring in New York State


With all of the rules, regulations, mandates, guidelines, certifications and restrictions placed on the health care industry, managing a viable Health Care Organization in one of this Nation’s most highly populated states can literally make a manager sick.  An advance in technology and the demand for more information faster requires a big change in the way business has been conducted over the past few decades.  Meeting the health care demands of an aging society needing health care means keeping up with those demands and keeping abreast of advancements in the technological society to stay ahead of emerging demands.

Technological challenges top the list of the most recent changes a Health Care Manager has had to face over the last ten years.  The biggest technological challenge has been the changeover of the paper version of the Federal Medicare and the State Medicaid systems to an electronic version.  As if these programs weren’t difficult enough to decipher, now we have to process it via binary code.  Technology can be a wonderful thing but it diminishes the capability of human discussion for matters that may contain extenuating circumstances.  Or, where the problem is not cut and dry so may not fall into an “A-Typical” diagnosis code.

eMedNY is the State of New York’s Medicaid claims processing system.  A contractor, Computer Sciences Corporation (CSC) is responsible for running this state’s electronic Medicaid filing system.  This system allows medical Providers to submit and track claims and receive payments electronically.  One of the challenges with this type of service and the magnitude of accessibility is computer fraud.  With the Health Insurance Portability and Accountability Act (HIPAA) of 1996, guarding accessibility to patient information became crucial to the daily operations of health care Providers.  eMedNY and Computer Sciences Corporation to not take responsibility if information is “not protected” at no fault of the system.  A recent warning was issued to all Providers that an unauthorized source was requesting information regarding users access ID’s.  Once notified, eMedNY and DHHS relinquish any responsibility for the release of any Protected Health Information (PHI) and the burden of security is the responsibility of the Provider who maintains this information.

In order to use the electronic Medicaid system, the medical provider was register is National Provider Identifier with the State of New York Department of Health and Human Services.  The Health Insurance Portability and Accountability Act (HIPAA) of 1996 brought about the mandate of a National Provider Identifier.  The State of New York Medicaid System transitioned to the use of the National Provider Identifier (NPI) for all Providers.  The final rule for adopting an NPI as the standard unique health identifier was published by the New York Department of Health and Human Services on January 23, 2004.  This ruling became effective May 23, 2005 and was mandated for usage by the New York Medicaid System on May 23, 2007.

Another challenge for the health care Provider is training on the electronic Medicaid system.  There are manuals and self help guides available from CSC in written and download versions, as well as training seminars.  The training seminars are held regionally and are limited to two (2) employees per Medicaid Provider ID.  They are also limited to specific job types like the Physician or his billing representative, to name a few.  So, a large organization that may have one Medicaid ID could not send their Human Resources Training Manager as he/she would not be an eligible participant.  So essentially, large practices and facilities would have to send two (2) qualifying candidates to the seminar who in turn would come back and teach the rest of the staff on the system.  Otherwise, the practice/facility would have to pay Computer Sciences Corporation a fee to provide on-site training to all staff members who would use the system.

Access to eMedNY claims and payment center isn’t as simple as clicking a link on the website main page.  A Point of Service (POS) device must be in place at the billing location in order to send and receive information through this service.  The VeriFone POS device is available from the Computer Sciences Corporation at a cost of $817 (includes shipping and handling).  Set up is the responsibility of the recipient.  The problem with this Point of Service Terminal is there is no guarantee it will work with the Providers telephone service; and neither the CSC nor the New York Department of Health can provide assurance that the device will work at the Provider’s location.  ePaces, short for electronic Provider Assisted Claim Entry System is a free web based application to the New York Department of Health, Medicaid Division.  It was developed by the Computer Services Corporation when New York’s Medicaid system converted from paper filing to electronic filing.  Paper filing is now the required practice for submitted Medicaid claims.  Paper filing of Medicaid claims in the State of New York is no longer practiced.  Though Medicaid Providers can submit their claims through this system, they cannot receive electronic payments from Medicaid using this method and would have to wait for paper check.  As will the POS device, this system access is as simple as clicking on a website.  The Provider’s computer software and internet access must meet specific criteria in order to be compatible with the ePaces Program.  To gain access to ePaces, the Provider must first ensure he has registered his NPI with the New York Department of Health and Human Services.  The computer software must have Explorer v4.01 or Netscape v.4.7 or higher, have NS Windows, Macintosh or Linux and Internet access via broadband connection or dial-up at 56Kbps or greater.

With all of the complications required of medical practices to obtain payments for Medicaid patients, payment which are well below their nominal fees and are rates they have no negotiating power over, that the cost is off-set in charges to private payers and private managed care organizations who do not rely on government funding.  The decline in quality health care in New York State and around the United States is partially contributed to the complexity of trying to keep up with the technological challenges and mandates of the government regulated programs that affect the health care industry.


All resources were researched via the world wide web


New York Department of Health, Press Releases 2000 – 2007

NY Heath Care Reform Act, 2007


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