The electronic health care record (EHR) or electronic medical record (EMR) initiatives pwill create both opportunities and risks.
American Recovery and Reinvestment Act includes an estimated net investment of $19 billion for health information technology. The standards-based health IT and health information exchange (HIE) will support new models of care delivery that are intended to be patient-centered, and physician-guided, reflecting a coordinated, collaborative approach.
Most Health Care Payers and Providers Are Under Estimating the Joint Requirements & Analysis Time for 5010 and ICD-10
If you are educating your team, considering the HIPAA 5010 time line or ICD-10 time line and milestones, performing vendor selection, establishing organizational structure, planning to replace your claims system, secure compliance attestation from clearing houses, review process impacts and improve process, or developing scoping and requirements documents our nationally recognized experts can help as an extension of your team. Both X12 5010 and ICD-10 will impact process across your organization.
Use this as an opportunity not just to comply but to innovate.
Click Here to Schedule a Free Evaluation with One of Our Industry Experts*
The implementation of the new X12 HIPAA 5010 transactions standard and the ICD-10 code set is a historic opportunity to upgrade the quality of health care data, but it comes at a cost. Cross walks and general equivalence mappings (GEMs) will not be enough. Process and systems impacts should be considered up front.
Blue Cross Blue Shield of Chicago estimates that the new standards contain over 850 individual changes.
Some industry experts complain that the new messages do not resolve some of the old problems while they create new ones, such as incompatibilities with the new IDC-10 codes.
To effectively make the transition from HIPAA 4010 to 5010 health industry IT professionals will need to analyze tens of thousands of lines of HIPAA programs thereby creating an extra burden on HIPAA users to use the new standards.
One cost is mapping between the old and new code sets, another is the unknown operations & process impact.
The 5010 Version is massive and includes more than 850 complex changes. For example, the changes to the
Healthcare claim, transaction 837, include 700 pages of instructions with a change on every page. This HIPAA
format conversion must be completed by January 1, 2012, in advance of the ICD-10 implementation in order
to accommodate the extended diagnosis/procedure codes.
It is also critical that during the 5010 conversion, payers and providers operate dual processing systems - one
to process live claims with 4010 formats and a second to process 5010 transactions for testing and analytics.
Many payers are separating X12 5010 standards analysis work from ICD-10 analysis work, yet the two conversions impact each other. There is risk of duplicating effort or missing requirements the first time using a sequential approach in moving to electronic health care record (EHR) and electronic medical record (EMR) standards.
Risk Mitigation Approaches
Operationalizing the new processes imposed by the 5010 standard is another issue as health insurance firms, providers and others look at the reality and limitations of their current systems and resources. When combined with ICD-10 and cost pressures, payers and providers tend to save cost now but risk more costs later in remediation work.
Determining what is practical as well as achievable will be necessary as these entities balance day to day operations and future expenditures for regulatory compliance.
A balanced approach of regulatory expertise, IT and operational expertise, and outside experts who can validate your requirements early before critical errors are made
Reduce Risk of Missed Compliance Dates with No World Borders HIPAA 5010 and ICD-10 Audits, Training & Reviews
Third Party Review of HIPAA Migration Plans to achieve EHR / EMR compliance.
Auditing of your HIPAA IT and business requirements impacts
Nationally Recognized Experts, formerly with Medicare, the U.S. Government, and Leading Technologists at Health Care Companies
Reduce Your Risk of missed deadlines, over Spending, and incorrect processes to meet these critical dates
Creation of mitigation plans that account for the impact of third party software that may not comply by the required dates
Evaluation of data integration hubs, data interchange standards and schema to aid in the HIPAA standards integration process
Development of "as is" and "to be" business process models to evaluate changes in your process based on changes to HIPAA transactions such as 997, 837, 835, 834, 820, 278, 277, 276, 271, 270.
Let us help evaluate your vendors (including the clearing house) regarding their strategy, time line, and costs
Train your team early for the business, IT, and operational impacts of HIPAA 5010 standards and ICD-10 to position your organization for electronic health record (EHR) / compliance.
Click Here to Schedule a Free Evaluation with One of Our Industry Experts*
No large health insurance firm we know of can afford to wipe away years of legacy systems and start fresh across their entire enterprise, even when facing sweeping changes in federal compliance rules and new standards. This poses important challenges that are not addressed by GEMs, cross walks, and other supporting documents. Some systems will need to be replaced, some retrofitted.
The No World Borders client services team is staffed with industry experts with in-depth knowledge of claims systems and supporting workflows and work streams which support provider management, customer service, financial systems integration, and the core claims process and standards. We have worked with payers in the U.S., Latin America and the EU to help optimize their process, data, and transparency to meet local regulations.
New Standards Experts, Judgment Based on Experience
Our consultants work with clients to ensure successful implementation of our partner solutions, and completion of a smooth migration to version 5010 and ICD-10. No World Borders Consulting Services provides the experience and knowledge experts to meet your 5010 migration requirements cost-effectively. While knowing the world of new standards is important, having the judgment and experience to know what is practical and how to achieve it in a heterogeneous organization and computing environment is essential.
Our relationships with Chief Medical Information Officers, the Workgroup for Electronic Data Interchange (WEDI), ANSI HITSP committee Centers for Medicare & Medicaid Services (CMS), Accredited Standards Committee (ASC), National Council for Prescription Drug Programs (NCPDP) and other groups give us visibility into current HIPAA Electronic Transaction Standards and future state standards.
Our services include:
Business Strategy and Process Re-engineering
Organizational development to establish a culture in your company that both enables and embraces change brought about by H.I.T.
EDI Evaluation and Data Management, including Use Cases and Step by Step Audit Frameworks
Strong regulatory, standards, and systems perspectives to provide the realistic mentoring to our clients
Ontology of knowledge of standards
On-staff consultants, and a network of over 450 health care IT professionals with relevant experience.
Health information exchange design based on service oriented architecture, HIPAA EDI data transport, HIPAA coding standards.
Systems Integration
Training & Education
Our experienced and professional services team can support and augment your internal 5010 migration and ICD-10 upgrade initiatives in the following roles:
Audit and review of migration requirements, whether developed by us or the client
General Equivalence Mapping (GEM) situational reviews to determine an implementation approach with your systems
Helping Your Team Be Successful, Achieving Results
At each stage of your implementation you may leverage our expertise to supplement your existing staff in handling time-critical projects as needed.
Serve as an extended arm of your team
Host education, training and other events for your team and partners
Capture lessons learned and product feedback
Provide detailed guidance to customers on best practices captured from hundreds of implementations
From initial configuration and setup to training, education and ongoing support, No World Borders provides a full spectrum of services to ensure that our clients' efforts are successful.
* Qualified health care payers and providers only. A 30 to 60 minute discussion will be scheduled at a mutually agreeable time, at no charge.
What You Need to Know Regarding Compliance HIPAA 5010 Regulations
The Administrative Simplification Act (ASCA) requires the use of electronic claims (except for certain rare exceptions) in order for providers to receive Medicare payment.
Therefore, effective January 1, 2012, you must be ready to submit your claims electronically using the X12 Version 5010 and NCPDP Version D.0 standards. This also is a prerequisite for implementing the new ICD-10 codes.
The Centers for Medicare & Medicaid Services (CMS) will provide additional information to assist you and keep you apprised of progress on Medicare’s implementation of HIPAA 5010 through a variety of communication vehicles.
Remember that the HIPAA standards, including the X12 Version 5010 and Version D.0 standards, are national standards and apply to your transactions with all payers, not just with Fee-for-Service (FFS) Medicare.
Therefore, you must be prepared to implement these transactions with regard to your non-FFS Medicare business as well.
Medicare expects to begin transitioning to the new formats January 1, 2011 and ending the exchange of current formats on January 1, 2012. While the new claim format accommodates the ICD-10 codes, ICD-10 codes will not be accepted as part of the 5010 project.
Additional Information About HIPAA 5010
You can find more information about HIPAA 5010 by going to http://www.cms.hhs.gov/ElectronicBillingEDITrans/18_5010D0.asp on the Electronic Billing & EDI Transactions page on the CMS website. Medicare has prepared a comparison of the current X12 HIPAA EDI standards (Version 4010/4010A1) with Version 5010 and the NCPDP EDI standards Version 5.1 to D.0, and has made these side-by-side comparisons available at this website. These comparisons may be of interest to other covered entities and their business associates.
Overview of ICD-10
The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). The code set allows more than 155,000 different codes and permits tracking of many new diagnoses and procedures, a significant expansion on the 17,000 codes available in ICD-9.
Work on ICD-10 began in 1983 and was completed in 1992
View Our HIPAA 4010 to 5010 / ICD-9 to ICD-10 Migration Services Brief & General Health Care Consulting Overview
