Facilitators:

Kit Cairns, Dean Health Greg 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?

The "Newspaper" Approach…

WHAT?

WHY?

WHEN?

WHO?

WHERE?

HOW?

WHAT?

All Covered Entities must migrate to X12 version 5010 for the following Healthcare Transactions: 837 P, I, and D claims (including COB) 835 health care payment and remittance advice 270/271 eligibility request/response 276/277 claim status request/response 278 referral certification and authorization 834 health plan enrollment/disenrollment 820 health plan premium payment NCPDP D.0, 5.1, and 3.0

WHAT (continued)?

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.

WHY?

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

WHEN?

5010: ICD10:

January 1, 2012 October 1 , 2013

Pretty straight-forward, right?

NOT!

WHEN (continued)?

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.

WHEN (continued)?

ICD10:

Begin initial compliance activities by January,

2011.

October 1, 2013: compliance date for all covered entities.

What about a contingency period?

WHEN (continued)?

NOT!

WHO?

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)

WHERE?

ALL OVER THE PLACE!!!

Databases Applications (internal and outsourced) Business processes Other?

HOW?

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)?

HOW (continued)?

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.)

HOW (continued)?

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 providers be trained, etc., etc., etc.).

interaction, billing, internal systems, vendor systems, will

HOW (continued)?

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: WEDI: CMS: www.hipaacow.com

www.wedi.com

www.cms.gov

CMS Transactions & Codesets:

http://www.cms.hhs.gov/TransactionCodeSetsStands/02_Tra nsactionsandCodeSetsRegulations.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_5010D 0.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

Contact Information: Kit Cairns [email protected]

608.294.6492

Greg Margrett [email protected]

262.953.2465