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Kathy Whitmire Chris Scarborough HomeTown Health, LLC.

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Presentation on theme: "Kathy Whitmire Chris Scarborough HomeTown Health, LLC."— Presentation transcript:

1 Kathy Whitmire Chris Scarborough HomeTown Health, LLC

2 1. Define the benchmark of readiness for transition to HIPAA 5010 on January 1, Identify the need for the 5010 conversion. 3. Define benchmarking and monitoring actions to engage in following the Jan 1st transition. 4. Define the date that HIPAA 5010 goes into effect.

3  Begins November 2 nd with training and checklists to ensure that all hospitals are ready! ◦ Discuss Example of changes ◦ Next Webinars  Nov 9 th  Dec 7 th  Dec 14 th ALSO  12 month - ICD-10 Readiness Program ◦ Led by Sherry Milton, Coding & Documentation Expert ◦ Begin in January

4 Agenda - Overview / Background - Changes - Expectations - How to be Prepared - Toolkit / Checklist - What’s Next

5  Healthcare reform of the 90’s ◦ Provide greater access to healthcare ◦ Address administrative concerns  HIPAA enacted in 1996 ◦ Need for changes to streamline healthcare  Standard format ◦ Designated code sets  Goal ◦ Decrease administrative costs by standardization

6  Standardize transfer of information  Specific to electronic transactions  Important to understand what is or is not permitted under HIPAA

7 Standard Transactions nameTechnical Name for Transaction Eligibility benefit inquiry and response270, 271 Claim status request and response276, 277 Request for referral, authorization, and response 278 Health plan premium payments820 Enrollment and disenrollment834 Claim remittance835 Claim submission (professional, institutional, and dental) 837

8  Implementation Guides ◦ Serve as instructions to vendors to program systems to ensure they are able to transmit data in compliance with HIPAA  Standardized Code Sets ◦ Identified as “medical” or “non-medical” ◦ ICD-9 ◦ CPT ◦ HCPCS

9  Need to upgrade from 4010 to 5010 ◦ 4010 developed in 2000, revised 2002  Technical issues  Accommodate new business needs  Remove inconsistencies  5010 ◦ Developed in 2006 – 2007 ◦ Approved by HHS in January 2009

10  January 1, 2012  59 days  Only 5010 transactions  4010 rejected as non-compliant  Can use 5010 before Jan 1  5010 needed to change from ICD-9 to ICD-10 ◦ Required October 1, 2013

11  Step #1- Impact Analysis  Step #2 – Contact your Vendors, Payers, Billing Services, & Clearinghouse  Step #3 – Installation of Vendor Upgrades  Step #4 – Internal Testing and Staff Training  Step #5 – External Testing with Clearinghouse, Billing Services, and Payers  Step #6 – Make the Switch to 5010

12  January 1, 2012 ◦ Must use only 5010 transactions  After Jan 1, 2012 ◦ Monitor the submission and receipt of these transactions  October 1, 2013 ◦ Switch from ICD-9 to ICD-10

13  Level I compliance ◦ means "that a covered entity can evidently create and receive compliant transactions, resulting from the compliance of all design/build activities and internal testing." We (CMS) expect covered entities to be testing throughout calendar year 2011, and to schedule testing as early as possible, to ensure sufficient time for corrective actions and re-testing.  Level II compliance ◦ means "that a covered entity has completed end-to-end testing with each of its trading partners, and is able to operate in production mode with the new versions of the standards.”

14  Changes on claims ◦ Anesthesia minutes revised – only total minutes ◦ Max number of diagnosis codes increased from 8 to 12  Need to check with vendors to fully understand all changes

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16  Work closely with vendors  Internal ◦ Organizational level ◦ Software / programming changes ◦ 5010 transactions installed correctly ◦ Vendor to assist ◦ Benchmark – successfully create / receive 5010 compliant transactions ◦ Contact clearinghouse if used

17  External ◦ Sending / receiving 5010 compliant transactions to business associates and trading partners through the channels used today ◦ Identify issues during transmission ◦ End-to-End testing  Ready to go Live  Test with sample of largest portion of revenue  Have you tested?

18  CMS “no delay in 5010 compliance deadline”  Unanticipated problems = delays  Most important steps ◦ TEST! ◦ Speak with trading partners

19  Decrease miscommunications ◦ Payer may not receive ◦ Duplicates ◦ Errors  Typical claims submitted in batches ◦ A dozen to hundreds ◦ Problem with a transaction – need to know if it’s all, some, or one

20  TA1 – report the receipt of the transmission ◦ Received ◦ Received with errors ◦ Rejected  999 – report any syntactical errors identified at the claim level  277CA – report total number accepted, pending, or rejected ◦ Provides reasons

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22 1. PROJECT PLAN 2. ASSESSMENT 3. IMPLEMENTATION 4. MONITORING

23 1. PROJECT PLAN ― Gain an understanding of the impact of the update to the 5010 transactions ― Look to your professional association(s) for information & resources ― Identify a project leader/project team ― Develop a project plan

24 2. ASSESSMENT ― Identify all HIPAA transactions you are currently doing ― Identify any HIPAA transactions that you are not currently doing, but want to implement now electronically ― Create a list of your payers, including a contact person, phone number, & address ― Identify your clearinghouse’s contact person’s phone/

25 ASSESSMENT cont’d ― Contact your vendor to determine their implementation plans for 5010 transactions ― Contact your billing service to determine their implementation plans for 5010 transactions ― Contact your clearinghouse to determine their implementation plans for 5010 transactions

26 ASSESSMENT cont’d ― Contact your payers to determine their implementation plans for 5010 transactions ― Identify any work flow processes that need to be modified

27 3. IMPLEMENTATION ― Identify when your vendor will install your updates ― Identify when your billing service’s system changes will be installed ― Contact your clearinghouse to determine when it can begin testing ― Contact your payers to determine when they can begin testing ― Complete internal testing

28 IMPLEMENTATION cont’d ― Complete external testing with billing service ― Complete external testing with clearinghouse ― Complete external testing with payers ― Conduct staff training ― Begin using 5010 transactions before or on January 1, 2012

29 4. MONITORING ― Monitor the exchange of the 5010 transactions ― Report any issues identified with the transactions to the appropriate organization DATES January 1, 2012 – Compliance with version 5010 transactions October 1, 2013 – Compliance with ICD-10 code sets

30 AMA Transaction Code Set Standards GetReady5010.orgGetReady5010.org – Free Webinars GetReady5010.org/Resources ICD-10 Code Set to Replace ICD-9 HIPAA 5010 Toolkit Questions??

31 NEWS:  New Members – Elbert Memorial & Chatuge Regional  New Partners – VendorMate and Data Rx – 340B for hospitals  New DCH Commissioner David Cook confirms keynote at Fall Conference EVENTS:  Nov 2 nd, 9 th, Dec 7 th, 14 th – Countdown to HIPAA 5010  Nov 16 th -18 th – HTH Fall Conference  Dec 12 th -13 th – HIPAA Compliance Officer Training  Jan 25 th – 26 th – GA Rural HIT Conference – Macon  Jan – Sherry Milton ICD-10 Readiness Training begins

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33 1. Define the benchmark of readiness for transition to HIPAA 5010 on January 1, Identify the need for the 5010 conversion. 3. Define benchmarking and monitoring actions to engage in following the Jan 1st transition. 4. Define the date that HIPAA 5010 goes into effect.

34 ANNOUNCING HOMETOWN HEALTH 12 TH ANNUAL FALL CONFERENCE November – Callaway Gardens SPEAKERS AND SESSIONS INCLUDE: KEY NOTE SPEAKER: David Cook, Commissioner of the Dept of Community Health DCH Medicaid – HP - CMO – Navigant Discussion PANEL: Dr Jerry Dubberly, Medicaid Director and Cheryll Collier, HP Georgia Redistricting Update - David Tatum, CHOA A New Day in the Future of Health Care SPEAKER: Kirk McGhee, Vice President and Regional Counsel for Kaiser Permanente GA Health Information Exchange – GA-HITREC – Dr Denise Hines Value Based Purchasing / ACO Discussion – Led by Michelle Madison, Attorney Health Insurance Exchange – What Hospitals Need to do to Prepare - Ryan Teague 4 Requirements for Survival in 2012 and Beyond – PANEL: Change -Sue Spivey, Technology- Brenda Jarrett, Leadership – Jeff Dunn, Revenue Mgmt – Lynn Byrd


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