facilitators: kit cairns, dean health greg margrett, netwerkes/ingenix
TRANSCRIPT
Facilitators:Kit Cairns, Dean HealthGreg Margrett, Netwerkes/Ingenix
Questions, questions, questions…
What are we doing here this afternoon?
What are we not doing here this afternoon?
Why are Kit and Greg standing up here?
WHAT?
WHY?
WHEN?
WHO?
WHERE?
HOW?
All Covered Entities must migrate to X12 version 5010for the following Healthcare Transactions:
837 P, I, and D claims (including COB)835 health care payment and remittance advice270/271 eligibility request/response276/277 claim status request/response278 referral certification and authorization834 health plan enrollment/disenrollment820 health plan premium paymentNCPDP D.0, 5.1, and 3.0
All Covered Entities must adopt the Internal Classification of Diseases (ICD10) coding format:
Procedure Coding System (PCS) for inpatient hospital procedure coding.
Clinical Modification (CM) for diagnosis coding.
Because of the Final Rule published by the US Department of Health and Human Services on 1/16/2009:
ICD10: http://edocket.access.gpo.gov/2009/pdf/E9-743.pdf
5010: http://edocket.access.gpo.gov/2009/pdf/E9-740.pdf
5010: January 1, 2012
ICD10: October 1 , 2013
Pretty straight-forward, right?
NOT!
5010: Achieve Level 1 compliance by December, 2010
Covered entities have completed internal
testing and can send and receive compliant transactions.
Begin Level 2 external testing with trading
partners by January, 2011.
All covered entities must be in production by January 1, 2012.
ICD10: Begin initial compliance activities by January, 2011.
October 1, 2013: compliance date for all covered entities.
What about a contingency period?
NOT!
All Covered Entities, including:PROVIDERS (doctors, clinics, hospitals, psychologists,
dentists, chiropractors, nursing homes, pharmacies – submitting information electronically for HHS standard transactions)
HEALTH PLANS (health insurance companies, HMOs, company health plans, gov’t health plans such as Medicare, Medicaid, etc.)
HEALTH CARE CLEARINGHOUSES (entities that process non-standard health information from another entity into a standard or vice versa)
ALL OVER THE PLACE!!!
Databases
Applications (internal and outsourced)
Business processes
Other?
Budgeting NOW for 2010 and beyond for both 5010 and ICD 10 changes!!!
Determining ROI for adopting new transactions your organization hasn’t utilized (270/271, 276/277, 835, etc.).
Determining responsibility for 5010 and ICD 10 work:
In house? Vendor(s)?
Perform gap analysis for 4010 to 5010 for transactions in use today, and/or confirm that your vendor(s) are doing this work for their systems.
Determine what a realistic testing schedule is, and factor in when trading partners will be ready (providers and clearinghouses if you are a payer, payers and clearinghouses if you are a provider, etc.)
If you utilize a clearinghouse, determine what its testing policy will be regarding specific provider testing; if testing directly with payer, determine their testing policies and schedules.
For ICD 10, determine from start to finish where this change will impact your organization: training for coders, patient intake/provider interaction, billing, internal systems, vendor systems, will providers be trained, etc., etc., etc.).
The HOW part of the 5010 and ICD 10 migrations is the part with the most challenges and potential pitfalls…there is a wealth of expert knowledge in this room…we need to leverage that knowledge to assist all covered entities.
What have we NOT mentioned/discussed that needs to be addressed?
What pitfalls and/or concerns has your organization already experienced or thought about?
What else can HIPAA COW do to assist you and your organization in making these migrations as painless as possible?
HIPAA COW: www.hipaacow.com
WEDI: www.wedi.com
CMS: www.cms.gov
CMS Transactions & Codesets:http://www.cms.hhs.gov/TransactionCodeSetsStands/02_TransactionsandCodeSetsRegulations.asp
ICD 10 Final Rule: http://edocket.access.gpo.gov/2009/pdf/E9-743.pdf
5010 Final Rule:http://edocket.access.gpo.gov/2009/pdf/E9-740.pdf
CMS HIPAA Standards Page (gap information links):http://www.cms.hhs.gov/ElectronicBillingEDITrans/18_5010D0.asp
CMS ICD 10 Fact Sheet: http://cms.hhs.gov/MLNProducts/downloads/ICD-10factsheet2009.pdf
X12 Presentation to NCVHS on 5010 changes:http://www.ncvhs.hhs.gov/070730p4.pdf
