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