Health IT Updates
Version 5010 electronic administrative transactions
All physicians, other health care professionals, payers, and clearinghouses that submit HIPAA transactions will be required to use only the 5010 transactions by January 1, 2012. If physicians are not ready, they risk claim rejections and interrupted cash flow.
If you electronically submit administrative transactions, such as checking a patient's eligibility, filing a claim, or receiving a remittance advice, either directly to a health insurance payer or through a clearinghouse, the version of the transactions currently in use will be updated. On January 16, 2009, the Department of Health and Human Services (HHS) announced that updated versions of the HIPAA transactions will be required for use by physicians and others on January 1, 2012. The Centers for Medicare and Medicaid Services (CMS), is the agency within HHS charged with overseeing compliance with the standards. The CMS Office of E-Health Standards and Services recently announced that it is delaying the enforcement of its rule requiring hospitals, physician practices, health plans and claims clearinghouses to switch to version 5010, but it is important to note that the compliance deadline for 5010 has not changed, and is still January 1, 2012. The enforcement discretionary period is for 90 days after the January 1 compliance date.
Changes in the 5010 transactions
Improvements in the 5010 transactions include clearer instructions, reduced ambiguity among common data elements used in different transactions, and elimination of redundant and unnecessary data elements.
The updated version of the transactions has data reporting requirements that differ somewhat from the current transactions. These changes may require you to collect additional data or report data in a different format. For example, in the 4010A1 version of the professional claim transaction, anesthesia services may be reported in actual minutes or in units of time. In the 5010 version, only actual minutes may be reported. Another example of a difference in the professional claim transaction is the reporting of the billing provider address. In 5010, the address can no longer be a PO Box or lockbox address.
To help you prepare for the January 1, 2012 Version 5010 HIPAA compliance deadline, the AMA has developed the 5010 Toolkit. The 5010 Toolkit is a compilation of the 5010 Fact Sheet Series and provides an overview of the work that needs to be done to implement the updated transactions.
For additional information including updating to and changes in the 5010 transactions, what practices can do to prepare for 5010 and a list of 5010 FAQs, click here. Understanding these changes and how they will affect your practice will prepare you for a smoother transition to the updated transactions.
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Free archived webinars are available for viewing through the GetReady5010 website, an education effort supported by a broad group of health care industry stakeholders representing providers, payers, government, and vendors, including the AMA, that are coordinating their efforts to support a smooth and timely transition to the 5010 transactions. These webinars will focus on testing of the version 5010 HIPAA electronic administrative transactions. The webinars feature speakers from the Centers for Medicare & Medicaid Services (CMS), provider and payer organizations, and offer practical information and early lessons learned on: 1) testing for large and small practices and facilities; 2) how to test with Medicare fee-for-service; and 3) testing with commercial payers and clearinghouses. Additional free webinars and tools are also available on the resources page on that website.
Source: www.ama-assn.org/go/5010
AMAGINE™ Physician Portal
Navigating the HIPAA and Health IT Deadlines, Penalties, and Incentives
The most recent webinar from the AMAGINE physician portal education series, Navigating the HIPAA and Health IT Deadlines, Penalties, and Incentives: Charting a Path on the Regulatory Road, provided an overview of the various deadlines, incentives and penalties associated with version 5010 administrative transactions, replacement of ICD-9 with ICD-10, updates to privacy and security requirements, and incentives for adopting electronic health records.
While physicians have been assessing their readiness for adoption of health information technology with the encouragement of incentive timelines under Medicare and Medicaid programs, timelines from other federal programs need to be addressed, as noncompliance carries the potential for penalties. Physician practices are facing a number of federal deadlines under HIPAA, ICD-10, and the Patient Protection and Affordable Care Act. These deadlines are spread out over the next 4 years and because they can affect physician practice operations, advance planning for compliance is required. Beginning January 1, 2012, version 5010 of HIPAA transactions will replace the current 4010/4010A1. While this deadline is only a short time away, the Center for Medicare and Medicaid Services (CMS) did announced on November 17 that it would not initiate enforcement action until March 31, 2012, thus providing a 90 day grace period for compliance. While compliance with the January 1, 2012 deadline for the use of the 5010 HIPAA transactions and code sets is primarily a technology issue addressed by the practice's billing service, clearinghouse, or EHR (for practices that have them), there are some aspects of compliance that practices will need to stay on top of. For example, there is a change in the 5010 requirements that requires the billing provider to enter a street address or physical location instead of a PO Box address. This information will need to be communicated to the billing service or clearinghouse. The American Medical Association website has additional information on the differences between 4010 and 5010 versions.
The Patient Protection and Affordable Care Act (2010) calls for the following deadlines: adoption of unique health plan identifiers (October 1, 2012), operating rules for eligibility request and response, and claims status (January 1, 2013), Electronic Funds Transfer (EFT) standards and operating rules for EFT and remittance (January 1, 2014), Claims Attachment Standard and operating rules for claims, referral certification and authorization, enrollment in a plan, and premium payment (January 1, 2016).
Perhaps the most daunting challenge facing physician practices is the conversion from the current medical data code set standard, ICD-9-CM (volumes 1, 2, and 3) to ICD-10-CM and ICD-10-PCS on October 1, 2013. From a technology standpoint most EHR systems will be ready for the conversion, but the challenge for practices involves training on the new coding system for accurate data entry. As with the HIPAA 5010 conversion, financial incentives are not being offered for conversion to new ICD-10 coding system. Penalties for noncompliance are enforced under HIPAA and consist of civil monetary penalties.
For the adoption of certified EHR systems and meeting stage 1 Meaningful Use objectives, 2012 represents the last year for maximum incentives under Medicare ($44,000 per physician over five years). For 2015 and later, physicians who do not successfully demonstrate MU will be subject to a penalty.
For more information on HIPAA, ICD-10, and Medicare EHR deadlines, penalties and incentives, go to the AMAGINE physician portal education series archived webinar: Navigating the HIPAA and Health IT Deadlines, Penalties, and Incentives: Charting a Path on the Regulatory Road.
To view additional archived webinars sponsored by Amagine, Inc. on both health IT issues from the education series and on products available through the AMAGINE physician portal, click here.
This information is intended as a brief overview; be advised that guidelines may differ for individual versus group practices. For complete guidelines, please visit the CMS website.
Dr. Popp is a pediatrician and internist who recently joined Lifetime Medical Associates. Based on experience, he is a strong believer that health information technology (health IT) can enhance the delivery of quality health care in group practice. Part of the provision of quality of care is the ability to have access to secure electronic communication to collaborate on patient care with other healthcare providers and to facilitate communication between physicians and their patients. Dr. Popp's practice uses the AMAGINE community portal which connects him to the United Physician (UP) organization and to other UP practices and physicians through HIPAA-compliant secure email communication. He sees the value of this platform as a way to improve the coordination of care by facilitating physician communication and the exchange of patient records and information.
In addition to the secure communication within Dr. Popp's physician organization, the AMAGINE community portal offers a variety of clinical applications, communication tools and resources with a single sign-on. Some of these applications include DrFirst Rcopia™ ePrescribing, WellCentive patient registry, PQRS reporting through Covisint DocSite™, AMAGINE™ Secure Email (for secure communications outside the UP community) and clinical support tools such as Epocrates® Online Premium, Harrison's Practice, and the diagnostic decision support application, Isabel PRO™.
Dr. Popp's favorite features of the AMAGINE physician community portal are the communication/message center to obtain meeting schedules and agendas, and the WellCentive patient registry, which is helpful in efficiently managing his patients and meeting incentive payment goals. For Dr. Popp, the registry is an important reason for using the portal because it provides clear benefits. He can pull patient data/information before each patient visit, which allows him to see what tests may be missing or what immunizations/wellness checks are required. Additionally, the registry alerts the members of the practice to missing or overdue tests (e.g., HbA1c) or screenings (e.g., mammograms, colonoscopies). Because a patient registry allows you to identify and manage patient populations, plan, manage and track care, follow-up phone calls and letters to patients were cut down by over half. While incentive payments for the use of health IT are helpful, Dr. Popp recognizes that these will eventually be phased out and the focus should be on the long-term benefits to the practice.
Dr. Popp recommends that other practices implement a platform like the AMAGINE physician community portal. The challenge for practices is dealing with the dynamics of the health IT process that can initially add to the workload of busy practices. Dr. Popp's advice is to find a health IT system that meets the needs of your practice and to start using it. Amagine, Inc. offers a free health IT assessment and a selection of EHRs for practices considering adoption of a complete certified EHR system. For those practices not ready to adopt a complete EHR, modular EHR options are also available. Most of his colleagues who have not implemented health IT are concerned that they will not recognize a cost benefit, but in Dr. Popp's past experience, that benefit could be significant. In his previous practice, this cost-savings was recognized after implementation of an EHR after approximately 15 months due to more efficient billing and coding. But more importantly, it improved the efficiency of the practice and ultimately, the quality of care. "We are all resistant to change, but in the delivery of patient care, change is coming and we as a profession need to embrace this change. For those who take this approach, their experience will be much less frustrating."
