HIPAA 5010 and ICD-10 Compliance Requirements

Beginning on January 1, 2012, a federal mandate will require health care providers, health plans and clearinghouses to use new standards in electronically processing electronic transactions claims, remittances, eligibility, and claims status requests/responses.  The changes are intended to improve transaction uniformity and streamline the reimbursement process.  Impacted organizations will need to upgrade processes and systems from current HIPAA 4010A1 transaction standards to the new 5010 standards, and complete internal and external testing, verification and validation to assure readiness and prevent disruption.  All impacted organizations must be ICD-10 compliant by October 1, 2013.

Why The Change?

1. The government and industry’s shared goal of providing higher quality, lower cost health care
2. The need to implement electronic data exchange for the vastly expanded ICD-10-CM and PCS code set transition that is mandated for compliance by October 1, 2013. 

What It Means To You

Are you impacted?  Yes, if your organization is a hospital, physicians office, clearinghouse, health plan, pharmacy, dentist or other participant in health care claim and reimbursement systems.

What should you do?   To successfully meet the deadlines health care organizations need to implement new computer software, or upgrade existing software, to process transactions using the upgraded ICD-10 code sets.  Computer software must be upgraded or enhanced, tested, and the results need to be documented to ensure compatibility prior to the deadline.  

Schedule and Deadlines

• January, 2009 - Begin Level 1 activities (gap analysis, design, and development)
• January, 2010 - Begin internal testing for HIPAA 5010 and NCPDP D.0
• December, 2010 - Achieve Level 1 compliance (covered entities have completed internal testing and can send and receive compliant transactions)  
• January, 2011 - Begin Level 2 testing period activities (external testing with trading partners and move into production; dual 4010A/5010 processing mode); begin initial ICD-10 compliance activities (gap analysis, design, development, and internal testing) 
• January 1, 2012 – 5010/D.0 compliance date for all covered entities 
• October 1, 2013 - The compliance date for ICD-10-CM and ICD-10-PCS 

Current Status

Many impacted organizations are struggling to get started with their remediation and testing projects, and have already missed important deadlines.  The availability of assessment and remediation tools, and the complexity and enormity of the effort for third parties and larger organizations, have combined to create a situation where more payers, providers and software vendors than expected are now behind in their plans to complete internal and external testing in time.  

Reflecting concern about the potentially disastrous effects of HIPAA claim rejections once the changes are enforced, the Centers for Medicare and Medicaid Services (CMS), a federal agency with the US Department of Health and Human Services, has instituted a 90-day grace period for HIPAA 5010 – meaning that although the compliance date remains January 1, 2012, the agency will not “initiate enforcement action” before March 31, 2012.

Apex3 HIPAA 5010 and ICD-10 Services 

Apex3 has a comprehensive offering of services to assist our clients with achieving compliance requirements ICD-10.  These services include the following:

• Assessment – assesses the pending impact and remediation needed for internal departments and systems, and external parties, and generates a report that identifies all the required changes in transactions, software applications and processes
• Program Management – defines goals and objectives, leadership, roles and responsibilities, tasks required to achieve compliance, issues management, creation of documentation, transition management, and measurement of progress via online dashboard
• Remediation – methodology to track, test and document process and systems compliance changes needed, including creation of test databases and testing new third party software releases and internally developed upgrades and modifications, validation of interfaces with external trading partners, and process re-engineering to support changes in systems and technologies
• Training – online e-learning tool developed by Certified ICD-10 professionals provides education without external training program costs
• Revenue Recovery – monitors revenue streams and safeguard against noncompliant impacts.

The assessment and remediation phases are supported by an automated toolkit that supports the following:

• automation of the assessment process across organizations, departments and systems
• standardized remediation workplan tracks progress of task forces, committees, departments and vendors
• best practice testing methodologies for managing test cases, test cycles, test scripts and results documentation
• integrated governance/issues/risk management functionality
• executive dashboard to monitor progress of stakeholders and participants.  

The tool links to documentation that can include vendor contracts, inventory of interfaces, and verification/validation of successful testing, consequently creating the documentation library necessary to support compliance efforts.  Reports can be used to track progress of outstanding compliance tasks that need to be completed prior to the deadline.

Contact Us Today at info@apex3llc.com for more information.

Convey positive power and communicate better with others.  Convert problems in to opportunities.  Don’t blame others, take responsibility.  Be open and honest, and tell the truth to earn credibility.  Here are some suggestions:

• Be Decisive:  Instead of saying “We should be ready by Friday,” say “We will be ready by Friday”; or instead of saying “Lets stop for questions and answers,” say, “What questions do you have?”
• Project the Positive:  Instead of saying “I’ll try to do it,” say “I’ll do it”; instead of saying “I think we can do a good job,” say “We’ll do a great job”
• Be Transparent:  Saying things like “to be perfectly honest” or “frankly, …” gives the listener the impression that sometimes you’re not honest or frank; also just say “no” (politely) if you cannot fulfill a request
• Give Credit to Others:  Thank others for their contributions, compliment others for their good work, and thank others when you receive a compliment
• Be Courteous:  use words like please, thank you, and you’re welcome
• Encourage Teamwork and Cooperation:  Instead of saying “That’s a bad idea, I don’t like it,” say “The idea has some merit, and here’s how we might improve on it”; rather than saying outright “I disagree,” you might say “I appreciate your thoughts, have you also thought about …”
• Bounce Back with Strength:  In the face of failure, remember what you’ve learned; if one thing doesn’t work, try another; if you reach a dead end, start over
• Be Responsible:  you’re not helpless, think about what you can do to make things happen

Making good decisions reflects the right balance of intellect and emotion, head and heart.  

• Ahead of time:  analyze needs v. wants, alternatives and consequences
• Head:  facts, objectives, practicalities, honesty, past experience
• Heart:  opinions, personalities, beliefs, intuition, ego, feelings
• Decision:  balances head and heart, practical and emotional

Good managers tell staff what they want to hear and also what they don’t want to hear, but need to hear, to optimize performance and growth.

Staff wants to hear…

• Thanks for arriving early
• I’m glad you’re here
• I’m glad you’re on this project
• You have great skills and experience
• You’re off to a great start
• Great idea
• Great question
• Excellent report
• Thanks for sending that email
• Your progress is on track, lets move on to the next steps
• Great work, we’re going to implement your recommendations
• I couldn’t have done it better myself
• Keep up the good work
• Everybody makes mistakes, I’m sure you’ll do better next time
• How can I help?
• You got this assignment because I'm confident you can do it well
• Thank you for all your hard work
• I’m recommending you for promotion
• I’m recommending you for a raise

Staff doesn’t want to, but should, hear … (but you need to tell them anyway)

• I need you to arrive earlier
• I’ll be watching your work closely to be sure you get it right
• What is your role on this project again?
• You need to speak up
• You need to do this assignment over and get it right
• You are not off to a great start, you need to make some corrections
• You need some new ideas, go back to your desk and work on them
• You are underperforming, you can do better
• You have a lot to learn before you are ready for additional responsibility
• Don’t bring me your problems, think how you would handle them and bring me solutions
• You should know better than to have made that mistake
• You need to work smarter and harder
• I’m not recommending you for a raise
• I’m not recommending you for promotion
• You need to listen better
• You need to work better with others

Use these “persuading” words to increase your influence and effectiveness when working with others…

• Accurate
• Ambition
• Beyond
• Clean
• Complete
• Courtesy
• Drive
• Economical
• Efficient
• Energetic
• Enormous
• Exceed
• Excel
• Focused
• Growth
• Health
• Maximum
• Motivated
• Necessary
• Performance
• Power
• Professional
• Progress
• Quality
• Results
• Satisfy
• Scientific
• Sociable
• Status
• Successful
• Sympathy
• Teamwork
• Tested
• Thinking
• Thorough
• Thoughtful
• Time-saving
• Value

Politics is a business fact of life – learn to play it well by refining the ways in which you communicate your work efforts and accomplishments to others.  Use your communications skills to shape others’ perceptions of you.  You want to be known as competent and capable.

• Don’t be cynical, critical or negative – be supportive and positive.  It’s OK to question others and express different opinions, but be a smart team player and go with the flow and support decisions or actions you may not fully agree with

• Put the time in and develop a reputation of being a hard worker.  Get to work early and stay late.  Work in the evenings and on weekends if necessary.  Others will notice and respect you for your effort and commitment.

• Keep others informed about your work.  Update your boss as frequently as he needs it, more frequently if he says he doesn’t need it.  Choose the right methods to communicate.  Copy others on emails and other messages as needed to keep them in the loop.   Return emails, text messages and phone calls timely.  Use face-to-face meetings, either in person or via Webex or Skype, as needed.

• Take advantage of opportunities to “volunteer” for additional work on ad hoc teams, special projects, volunteer activities, intramural teams, etc.  Each opportunity offers the chance to meet new people, make new contacts, and build your growing reputation.  It also gives others a chance to get to know you.

• Recognize the accomplishments of others.  When someone is promoted or recognized for an accomplishment, send them a note of congratulations.  When someone new joins the team, welcome him or her in person or send him or her a welcome message.  When someone leaves, wish him or her success or send him or her an email for success in his or her new opportunity.  When someone makes a contribution to one of your projects, thank them or send them a message for their file.

Sometimes when project managers go through tough times on a project they can become tentative and cautious.  They tend to be more careful in their actions and decisions – likely because they are more uncertain about the outcome.  The result can be erosion of personal and managerial authority, influence and control.

Remain confident and strong.  Resist the temptation to reel in the talents and capabilities that make a PM successful.  Empower.  Tough times and tough projects require leadership, decisive action, strength and momentum.  Your team is likely depending on your authority and confidence.  Go on offense and make things happen.

• Do what it takes – arrive early, stay late when needed, excel in your responsibilities and deliverables, grow your skills and knowledge

• Communicate well – alert others to avoid surprises; share status, issues, progress, and results; listen well, speak well, and select the right medium for the message (i.,e, face to face, email, text, written document, etc.)

• Quick learner – press your full abilities and efforts into learning new things, get up to speed as quickly as possible, then leverage your new knowledge into your work

• Positive Attitude – put it on display all the time, you can stand out from others and also influence others to be more pleasant and contribute to a positive workplace environment

Evaluate each assignment or task

Define the factors that will determine priority

Understand the consequences of priorities on assignments/tasks

Determine the priority of each assignment/task

Ask for help if needed – from colleagues, associates, managers, etc.

Finalize the priorities

Hold unprioritized assignments/tasks in a “parking lot” for the next review