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HIPAA-AS 5010: The Final Chapter Post Implementation

HIPAA-AS 5010: The Final Chapter Post Implementation. Objective: To understand how key challenges of the HIPAA-AS 5010 mandated requirements, customer demands and operational disruptions were mitigated during this period of regulatory change. AAHAM - Greater Florida Buccaneer Chapter.

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HIPAA-AS 5010: The Final Chapter Post Implementation

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  1. HIPAA-AS 5010: The Final ChapterPost Implementation Objective: To understand how key challenges of the HIPAA-AS 5010 mandated requirements, customer demands and operational disruptions were mitigated during this period of regulatory change. AAHAM - Greater Florida Buccaneer Chapter March 21, 2012 900-2891-0312

  2. HIPAA-AS 5010: The Final ChapterPost Implementation Agenda HIPAA-AS 5010 Background and Fundamentals Health Care Industry Implementation Challenges Implementation Experiences and Common Trends Future Considerations Helpful Resources Questions and Discussion 900-2891-0312

  3. 5010 Background and FundamentalsWhat do we know and what do we remember? • The federally mandated HIPAA-AS (Health Insurance Portability and Accountability Act – Administrative Simplification) standard covered electronic transactions and medical code sets are changing. • On January 16, 2009, the DHHS announced the final rules for electronic transactions (Version 5010) and the new medical code set standards (ICD-10). • Compliance dates are January 1, 2012 for the updated electronic transactions (5010) and October 1, 2013 for the new medical code set standards (ICD-10). • A transition period for implementing the new electronic transaction standards began on January 1, 2011 and ended on December 31, 2011 (CMS Delayed Rule Enforcement periods!); there is no transition period for the new medical code sets. • External trading partner testing and the 5010 transition will require significant communication, collaboration & coordination across the health care industry. • The implementation of 5010 is a pre-requisite to the implementation of the new mandated ICD-10 medical code sets. 900-2891-0312

  4. 5010 Background and FundamentalsWhat do we know and what do we remember?(continued) • HIPAA-AS 5010 incorporates more than 1331 changes (607+ just for claims) to the current standard and will provide the following business values: • Improvements to the structure of electronic transactions will increase the value of data and the rules that govern data content while enabling future capabilities. • Changes will resolve current data ambiguities and inconsistencies across the HIPAA-AS standard covered electronic transactions. • Changes will increase the business value of the HIPAA-AS electronic transactions while enabling future capabilities for interoperability between industry stakeholders. • Significant impacts to provider billing and payment processing will be realized across the health care industry if stakeholders fail to collaborate, coordinate and communicate throughout these periods. 900-2891-0312

  5. Health Care Industry Implementation Challenges 900-2891-0312

  6. Implementation Experiences and Common Trends • Preparedness and varying degrees of readiness of health care industry electronic trading partners. • Technical and business process challenges to support internal and external end-to-end testing. • Common understanding and agreement of regulatory compliance requirements and their interpretations. • Regulatory rules, payer specific business rules and data content usage across the health care spectrum caused confusion among electronic trading partners. • Communication, training and education. • Inherent complexity of electronic trading partner integration. • Priority conflicts and implementation cost considerations with other business; clinical; regulatory and administrative initiatives. 900-2891-0312

  7. Future ConsiderationsWhat’s next? • We are entering a period “extreme standardization” and change! • HIPAA-AS Electronic Transactions and Code Sets (ICD-10) • HITECH; HIPAA-AS Privacy and Security • Health Care Reform and Operating Rules • Meaningful Use and Minimum Necessary • Mandated Electronic Funds Transfer (EFT) • Convergence of PMS; HIS; Billing Services • Electronic Medical Records • Mandated Claim Attachments • Merging of PCP’s and PA Groups • e-Prescribing • Others (?) 900-2891-0312

  8. Helpful Resources Where can we find out more information? • Access publically available Websites (a few examples follow): www.cms.gov/home/regsguidance.asp www.wedi.org/ www.ama-assn.org www.himss.org/ASP/index.asp www.hbma.org www.ahima.org/Default.aspx www.bcbsfl.com www.availity.com www.aaham.org getready5010.org 900-2891-0312

  9. Questions & Discussion Thank You! 900-2891-0312

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