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Medicaid Webinar 11-2-2011. Kathy Whitmire Chris Scarborough HomeTown Health, LLC. Learning Outcomes. Define the benchmark of readiness for transition to HIPAA 5010 on January 1, 2012. Identify the need for the 5010 conversion. - PowerPoint PPT Presentation
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Medicaid Webinar11-2-2011
Kathy WhitmireChris Scarborough
HomeTown Health, LLC
1. Define the benchmark of readiness for transition to HIPAA 5010 on January 1, 2012.
2. 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.
Learning Outcomes
Begins November 2nd with training and checklists to ensure that all hospitals are ready! ◦ Discuss Example of changes◦ Next Webinars
Nov 9th Dec 7th Dec 14th
ALSO 12 month - ICD-10 Readiness Program
◦ Led by Sherry Milton, Coding & Documentation Expert
◦ Begin in January
Countdown to HIPAA 5010
Agenda Overview / Background Changes Expectations How to be Prepared Toolkit / Checklist What’s Next
HIPAA
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
HIPAA Background
Standardize transfer of information
Specific to electronic transactions
Important to understand what is or is not permitted under HIPAA
HIPAA Background
HIPAA Electronic Transactions
Standard Transactions name Technical Name for Transaction
Eligibility benefit inquiry and response 270, 271Claim status request and response 276, 277Request for referral, authorization, and response
278
Health plan premium payments 820Enrollment and disenrollment 834Claim remittance 835Claim submission (professional, institutional, and dental)
837
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
HIPAA Background
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
HIPAA Background
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
Moving to 5010
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
HIPAA 5010 Implementation Steps
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
HIPAA 5010 Implementation Dates
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.”
HIPAA 5010 Compliance
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
WHAT’S DIFFERENT IN HIPAA 5010
WHAT’S DIFFERENT IN HIPAA 5010
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
TESTING YOUR READINESS
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?
TESTING YOUR READINESS
CMS “no delay in 5010 compliance deadline”
Unanticipated problems = delays
Most important steps ◦ TEST! ◦ Speak with trading partners
PREVENTING CASH FLOW INTERRUPTIONS DURING
TRANSITION
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
USING ACKNOWLEDGEMENT TRANSACTIONS
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
USING ACKNOWLEDGEMENT TRANSACTIONS
1. PROJECT PLAN
2. ASSESSMENT
3. IMPLEMENTATION
4. MONITORING
5010 CHECKLIST
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
5010 CHECKLIST
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, & email address
― Identify your clearinghouse’s contact person’s phone/email
5010 CHECKLIST
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
5010 CHECKLIST
ASSESSMENT cont’d― Contact your payers to determine their
implementation plans for 5010 transactions
― Identify any work flow processes that need to be modified
5010 CHECKLIST
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
5010 CHECKLIST
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
5010 CHECKLIST
4. MONITORING― Monitor the exchange of the 5010 transactions― Report any issues identified with the transactions to
the appropriate organization
DATESJanuary 1, 2012 – Compliance with version 5010 transactions October 1, 2013 – Compliance with ICD-10 code sets
www.ama-assn.org/go/5010
5010 CHECKLIST
AMA Transaction Code Set Standards GetReady5010.org – Free WebinarsGetReady5010.org/ResourcesICD-10 Code Set to Replace ICD-9HIPAA 5010 Toolkit
Questions??
RESOURCES
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
ConferenceEVENTS: Nov 2nd, 9th, Dec 7th, 14th – Countdown to HIPAA 5010 Nov 16th -18th – HTH Fall Conference Dec 12th -13th – HIPAA Compliance Officer Training Jan 25th – 26th – GA Rural HIT Conference – Macon Jan – Sherry Milton ICD-10 Readiness Training begins
HomeTown News & Events
1. Define the benchmark of readiness for transition to HIPAA 5010 on January 1, 2012.
2. 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.
Learning Outcomes
ANNOUNCING HOMETOWN HEALTH 12TH ANNUAL FALL CONFERENCE
November 16 - 18 – Callaway Gardens
SPEAKERS AND SESSIONS INCLUDE:
KEY NOTE SPEAKER: David Cook, Commissioner of the Dept of Community Health
DCH Medicaid – HP - CMO – Navigant DiscussionPANEL: Dr Jerry Dubberly, Medicaid Director and Cheryll Collier, HP
Georgia Redistricting Update - David Tatum, CHOA
A New Day in the Future of Health CareSPEAKER: 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