Once upon a time, there was a law enacted that protected
personal health information. While setting out to ensure individual privacy,
HIPAA has morphed into a reporting headache that continues to repeat.
Because of the law’s complexity, it has been implemented in
stages. The latest stage to appear on the horizon – compliance with Version
5010 – adoption of an electronic transaction standard for, among other things, Medicaid pharmacy
subrogation. Also, the rule adopted two standards for billing retail pharmacy
supplies and professional services.
By all accounts, 5010 is a more complicated version of the
current 4010A1 standards. Changes include codes designating principal
diagnosis, admitting diagnosis, external cause of injury, and reason for visit.
That means new codes. Therein lies the latest challenge.
Adoption of the new ICD-10 codes, effective October 1, 2014,
will require changes across the entirety of the healthcare industry. If you
deal with HIPAA – even non-Medicare/Medicaid HIPAA – the changes will affect
you. What companies should be doing now:
Early adoption.
In its tenth revision, the ICD-10 codes, set forth by World Health
Organization, are now expected to be in place by the 2014 date. All “HIPAA
covered entities” must use the codes. The sooner companies adopt the structure,
the more time there is to learn a more complex code set.
Test and implement.
The law has warned that “if you are not ready, your claims will not be paid.
Preparing now can help you avoid potential reimbursement issues.” Despite the
deadline moving (the previous deadline for implementation was October 1, 2013),
companies adopting the standard sooner can avoid denial of claim issues when
the new law finally takes effect.
Train staff.
Transitions can be tough, especially when using new coding structures. Set up
training sessions and provide printouts of the new processes and codes to all
employees. The ICD-10 codes amass over 14,000 codes – much more than typical
coding structures. Thus, the learning curve could be steep.
Plan a side-by-side,
gradual implementation. Probably the best way to transition is by building
a plan that allows for partial transitions of the business over to the new
coding system. The goal is to maintain claims and work flow while the
transition is occurring.
Enlist help. It’s
daunting to run a business while learning an entirely new electronic structure.
Look for HIPAA specialists who can help train and transition your company
faster.
While HIPAA, like other regulations, is an ever-changing
environment, companies can stay compliant with a bit of planning. When in
doubt, get help. Compliance means fewer denials, which results in a smoother
workflow.
