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Get the Inside Track With URAC

Posted on May 3, 2013 by Danyell Jones

URAC Invitation

URAC is Hosting a Pre-Conference Informational Session, Reception, and Business Track Session at the 2013 Armada Specialty Pharmacy Summit

If you are looking to get the inside track on the increased importance of accreditation programs in the specialty pharmacy marketplace, attending URAC’s pre-conference informational session should be added to the top of your list.  Not only is the session open to everyone but it will be followed with an open reception where you can meet URAC experts who can address your specific questions and needs.

The Armada Summit is the largest gathering of Specialty Pharmacy professionals in the nation and is taking place in 2013 at the Wynn Resort in Las Vegas, May 7th through May 10th. The Summit has historically delivered dynamic networking, educational and exhibiting opportunities.

URAC Pre-conference Informational Session: The Importance of Accreditation in Today’s Marketplace

URAC will kick off its Armada Summit activities with a pre-conference informational session on May 6th from 4pm to 5pmin the Lafleur Room at the Wynn Resort, Las Vegas.  The informational session is entitled “The Importance of Accreditation in Today’s Marketplace” and will explore not only how the evolution of the field of Specialty Pharmacy has changed over the years, but also how URAC Accreditation plays an important part in today’s expanding Specialty Pharmacy Marketplace.

 

 

URAC Hosted Cocktail Reception

URAC will be following up its pre-conference information session with a Cocktail Reception allowing for networking and discussion around URAC and the Specialty Pharmacy Industry.  Attendees will gather from 5pm to 6pm at the Lafleur Patio of the Wynn Resort, May 6th.  For additional information, or to RSVP for this reception, attendees should contact Rebecca Sheehan at rsheehan@urac.org.

Armada Specialty Pharmacy Summit Conference – Business Track Session: Proving Value in the Era of Health Care Reform

In addition to the pre-conference informational session and cocktail reception, URAC Senior Vice-President, Vernon Rowen will be presenting a business track session during the specialty pharmacy summit entitled “Proving Value in the Era of Health Care Reform: The Advantage of Accreditation.”  The business track session is open to attendees and will occur Thursday, May 9th from 3pm to 3:45pm in Mouton 2 of the Wynn Resort.  Attendees can expect to gain further insight and perspective on URAC Accreditation for Specialty Pharmacy, as well as how Accreditation is valuable from a business perspective in the era of healthcare reform.

Additional Information on the 2013 Armada Specialty Pharmacy Summit:

Full agenda of 2013 Armada Specialty Pharmacy Summit Activities : http://www.armadasummit.com/


Posted in Accreditation | Tagged 2013 Armada Specialty Pharmacy Summit, Health Care Reform, URAC, URAC Accreditation, URAC Specialty Pharmacy | Leave a comment

Healthcare Wars and Legal Challenges Infographic: Top 5 Take Aways

Posted on October 12, 2012 by Danyell Jones

Top 5 take aways for Healthcare Wars and Legal Challenges
Continuing along with some of my favorite healthcare infographics is a great compilation from loveinfographics

So what are the top 5 takeaways here….

1. There is a call for healthcare change, backed by a demand for healthcare strategic management and despite the fact that the solution to the problem is not agreed upon the evidence is clear that the number of uninsured and underinsured continues to grow
2. Healthcare laws will continue to evolve, but more slowly than reform with a current emphasis on privacy and patient protection
3. Healthcare IT Initiatives will continue to grown and develop, again trying to keep pace with a rapidly evolving environment
4. The shortage of IT professionals in health will pose an ever increasing challenge to meeting the demands of healthcare IT and quality improvements for healthcare
5. This will open up a highly competitive and lucrative market for Health IT specialists, an occupational area that will see continued demand for the next decade

 

 

Source: loveinfographics.com via Gillian on Pinterest


Posted in Health Care Reform, Quality Improvement Programs, Uncategorized | Tagged Health Care Reform, healthcare IT, healthcare IT outlook, Healthcare Strategic Management, Healthcare Wars Infographic, Quality Improvement for Healthcare, Quality Improvement in Healthcare | Leave a comment

What the Hill is Going on With Healthcare Reform? What Just Happened?

Posted on July 3, 2012 by Linda Ringquist

Original source – The Hill Website

So many questions, so many points of confusion.  Healthcare Reform, a.k.a.ObamaCare, is a 2,700 page document that was created in 2010 by Barack Obama and his constituents. It was passed through very quickly and not sure anyone in the country has read and/or understands the bill in its entirety.

The Supreme Court made a monumental decision Thursday June, 28, 2012 regarding Healthcare Reform. The individual mandate was deemed constitutional in a 5-4 decision headed up by Chief Justice John Roberts.

One point of confusion surrounding this mandate is “Is it a tax or a penalty”? Many heated debates have taken place on this issue. Even the Supreme Court has come up with the premise that it is a tax if it is deemed it be so. How’s that for a definitive answer?

According to www.ivn.us, the Supreme Court ruled that for the purposes of the Constitution, it is a tax, because it functions as one. According to a blog, On page 12 of the opinion, Roberts points out that “Congress cannot change whether an exaction is a tax or a penalty for constitutional purposes simply by describing it as one or the other.” What he implies is that the ACA penalty is a “tax” under the constitution because that is how it functions. Congress has no power to change what a “tax” is, just by calling it a “penalty”. However, with respect to the Anti-Injunction Act (and the ACA), Congress can decide that a “tax” or “penalty” is whatever they intend it to be (as opposed to what it actually is), because Acts are creatures of Congress. If a law is a creature of Congress, they get to decide what the terms are supposed to mean.

 

The historic ruling had all kinds of reactions and some of the networks, including CNN and Fox News, gave erroneous information as to the ruling. They had both indicated the mandate had been overturned. How do you get that wrong?

 

The decision is met with mixed feelings across the country. In general, it appears the Democrats are in favor of the mandate, while the Republicans are opposed. Here are some quotes for your reading pleasure.

 

Senator John Kerry was very happy with the ruling.

Former Representative David Wu (democrat from Oregon) was seen smiling after the ruling.

Representative Cynthia Lummins (republican from Wyoming) was shaken. She said “I know it is a 200-page decision, I know it’s confusing. All I can tell you right now is, whatever’s left of it, I’m going to try to repeal in its entirety.”

Spokesman Adam Jentleson was visibly happy as he raced down the stairs of the Capitol.

Juan Williams, a columnist from The Hill, said “It is a big day for the Obama administration.”

Republican National Committee Chairman Reince Priebus said, “Just elect Romney. We need Full Repeal.”

Representative Kevin Brady (republican from Texas) said, “I think it will give President Obama a boost in the short term… It will motivate a lot of independents and Republicans to go to the polls because we know now the only way to overturn the ruling is at the election box.”

Representative Allen West (republican from Florida) said “ This is not something that gives the president a green light. I think this was worst-case situation for him.”

Republican Steven LoTourette responded to the question of what the ruling means politically, “I’m not smart enough to tell you that.”

House Majority Leader Nancy Pelosi (democrat from California) responded “This decision is a victory for the American people.”

Former Alaska Governor Sarah Palin (republican) said “Obama lied to the American people. Again. He said it wasn’t a tax. Obama lies, freedom dies.”

Senator Reid said “I’m happy. I’m pleased, that the Supreme Court put the rule of land ahead of partisanship.”

Senator Minority Leader Mitch McConnell said “Well, he Supreme Court has spoken. This law is a tax. The bill was sold to the American people on a deception.”

House Majority Leader Eric Cantor announced that the House will vote to repeal the law on July 11.

Representative Michele Bachmann criticized the ruling from an activist court, says the law can be repealed if House and Senate have GOP majorities and Mitt Romney is in the White House.

Mitt Romney said, “ObamaCare was bad policy yesterday. It’s bad policy today. Obamacare was bad law yesterday. It’s bad law today.”

Representative Joe Wilson (republican from South Carolina) “The decision reveals Obamacare is a huge tax increase on the middle-class taxpayers, destroying jobs.”

President Obama calls the decision “a victory for people all over the country.” He said he didn’t pursue healthcare reform because it was “good politics” and added, “I did it because I believed it was good for the country.”

House Speaker John Boehner (republican from Ohio) said the ruling would “strengthen the resolve of the GOP to repeal the law entirely.

Gary Ackerman (democrat from New York) held up a sign, “Obama-Roberts 2012”.

This is definitely not the end of this issue, but just the beginning. In July, look for a repeal to be filed. Then we can start all over with all of the comments and debates. Please visit The Hill for the full stories on Healthcare Reform. Just since June 28, 2012, they have posted more than 75 stories for your reading pleasure. It is a truly informative site.


Posted in Financial, Health Care Reform, Health Insurance | Tagged Health Care Reform | 2 Comments

HIPAA Security Explored

Posted on January 21, 2012 by Kathleen Rand

A significant provision of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires the Department of Health and Human Services (HHS) to adopt national standards for electronic health care transactions and national identifiers for providers, health plans, and employers. To date, the implementation of HIPAA standards has increased the use of electronic data interchange. The Affordable Care Act of 2010 will further these increases and include requirements that will be necessary to adopt. In addition, health plans will be required to certify their compliance. The Act provides for substantial penalties for failures to certify or comply with the new standards and operating rules.

Given the above stipulations, we are going to explore the some issues pertaining to HIPAA computer and technology security.

One of the first steps is to understand why computer security in healthcare is so important. It seems rather rhetorical: the answer is because everyone cares about the privacy and integrity of their health information. In most cases, the point of computer security is to prevent personal health information from falling into the wrong hands or being inadvertently altered or destroyed.

The HIPAA security standards apply to protected health information (PHI) that is either stored or transmitted electronically. PHI is health information in any form that personally identifies a patient.

Computers have made the issue of identity much more problematic. People have always been able to use someone else’s identity for criminal purposes, but the problem is aggravated when we can’t use physical means to confirm their identity. How do you know the person whose name is attached to an electronic health record (EHR) entry really made it? It’s difficult. The bottom line is this: Computer security is needed to protect the privacy of those whose information that is stored and managed. It is also needed to protect an organization from the risk of penalty and legal liability if private information is used or released.

The HIPAA security standards require healthcare organizations to have written security policies and procedures, including those that cover personnel training and sanctions for security policy violations. Your office staff and colleagues must truly understand basic security logic and take their role in protecting patients’ privacy very seriously.

The HIPAA security standards require your practice to appoint someone as the security manager, so you might want to assign these tasks to that person. Furthermore, an organization must also understand what encryption will do and when it is necessary. Contrary to what many people are saying, the HIPAA security standards do not require e-mails, or any other transmission from a doctor’s office, to be encrypted. The standards do require your practice to assess whether its unencrypted transmissions of health information are at risk of being accessed by unauthorized entities.

Encryption is the transformation of a message from plain text into nonsensical cipher text before the message is sent. Anyone who steals the cipher text message will not be able to understand it. Only those who have the code used to encrypt the message can convert it back from cipher to plain text and reveal its meaning.

For several reasons, encryption is generally not employed for information stored on a computer’s hard disk or transferred within an office’s local area network. First, the risk of disclosure to unauthorized parties is small in the closed environment. Second, encrypting data is costly. Third, encryption generally slows down the movement of information within software applications and databases.

The HIPAA security standards require an organization to obtain assurances from business associates that they will implement the necessary safeguards to protect the confidentiality, integrity and availability of the electronic health information they create, maintain or transmit on behalf of the organization.

Remember that there is no one-size-fits-all approach for computer security. What counts is being “reasonable and appropriate” when matching security measures with the level of risk that pertains to an organization’s situation.


Posted in Compliance | Tagged Affordable Care Act, Compliance in Healthcare, Health Care Reform, Healthcare Consulting Firm, HIPAA | 2 Comments

Mental Health Parity Law-Effective After Three Years?

Posted on December 19, 2011 by Kathleen Rand
BHM Mental Health Parity

Be Prepared for the Change

It has been three years since the mental health parity law went into effect, but, according to a recent GAO (Government Accountability Office) report, there has been little change in the percentage of employers that offer mental health coverage. The law requires employers make mental health benefits as comprehensive as those for medical and surgical treatments. Plus the report found little evidence that mental health utilization has increased despite the fact that the law eradicated restrictions such as limitations on outpatient visits.

Before the Mental Health Parity and Addiction Equity Act of 2008 became law, many feared that it would lead to skyrocketing health coverage costs and that some employers might drop mental health benefits altogether to avoid complying with the law. GAO’s results indicate those fears were largely unsubstantiated. According to a survey it conducted, 96% of employers that offered mental health benefits in 2008 continued to do so in their current plan year, while only 2% cut coverage.

It seems that the removal of limits and changing copays doesn’t translate into more and more people going to behavioral health clinic. There are obstacles to overcome in order for people to become comfortable using these services. Some of those hurdles include the stigma associated with mental illness and the fact that the value of counseling is sometimes unrecognized.

The greatest impact of the 2008 law has been the removal of limits on office visits and inpatient days. And the reform law will expand coverage to more Americans beginning in 2014, and will include mental health as an essential benefit. While that will more than likely cause some rise in mental health utilization, it usually takes two to three years for the impact to be fully felt. However, in states where public mental health services were cut, there could be some bottled up demand in the beginning, but that is expected to level off also.

The fact that utilization has not gone up is likely due to plan designs and the law’s relatively recent implementation. Employees who are enrolled in an open-access plan — such as a PPO or account-based product — have a choice between using participating or nonparticipating providers, and they may be more likely to seek services.

A more appropriate survey might have been to see how much utilization and expenditures have changed since 1996, when the first federal mental health parity law went into effect. In fact, since 2008, cost sharing for mental health benefits hasn’t changed much. For example, in 2008, the average mental health office visit copay and coinsurance were, respectively, $25 and 21%. In the 2011 plan year, the figures are $26 and 19%.

It appears that most employers did not drop mental health coverage, possibly because they have come to recognize the importance of mental health in the overall well-being of their work force. Behavioral health conditions left untreated often result in increased medical costs, reduced productivity, increased absences, and higher accident and error rates.

Despite the parity law, some employers are trying to control mental health spend and utilization. In fact, for many employer-sponsored health plans, an outside company is often hired to manage mental health benefits, which includes doing preauthorization to make sure treatments are medically necessary.

And while the law eliminated most cost controls, some restrictions still remain, such as excluding certain diagnoses from coverage or certain treatments for covered conditions (e.g., alternative medicine), and limiting levels of care, such as residential treatment centers.

Since utilization of mental health services hasn’t increased since the mental health parity law took effect, more changes are likely necessary. For instance, better explanation of the law so employees more fully understand it, more education around mental health disorders to improve awareness, and increased coordination between medical and behavioral health services which will lead to greater access to quality care.


Posted in Health Care Reform | Tagged Compliance Healthcare, Health Care Reform, Mental Health Parity | 27 Comments

Meet the Staff of BHM!

Posted on November 10, 2011 by Kathleen Rand

Hi there! For the next several blog posts, BHM would like to take a moment to introduce you to a few members of our staff and to provide an overview of our services. Our health care consultants bring a collaborative, knowledge based, and broad building style to every project resulting in measurable results. We do this by joining an organization’s management team and providing data-driven solutions and improvements.

We’ll start with our President and CEO, Mark Rosenberg. He has both an MD and a PhD and has been a professional management consultant for decades. Dr. Rosenberg has many years of experience in the management of healthcare programs in both the public and private sectors of healthcare. In addition, Dr. Rosenberg has been the featured presenter, or keynote speaker at more than 20 conferences across the United States.  Most recently, Dr. Rosenberg has been focused on assisting providers and delivery systems in improving their overall profitability and efficiency.

BHM Healthcare Solutions offers a vast array of services aimed at optimizing the financial and operational performance of health care enterprises. And with healthcare reform and the Affordable Care Act in the process of being implemented, the financial and operational well-being of your entity is more pivotal than ever.  Our organization provides services both nationally and internationally working with insurers, government agencies and heath care providers. As specialists in health care management consulting, we are able to improve the efficiency, profitability, and processes of an organization. Whether you are looking for physician advisor services, or help with successful accreditation, BHM can assist you in finding a customized program that will fit the needs, budget, and demands of your business.


Posted in Learning Series | Tagged Behavioral Health Management, Behavioral Health Prevention, BHM Healthcare Solutions, Compliance in Healthcare, Cost Effective, Health Care Reform, Healthcare Consulting Firm, Improving Health Care Profitability, Mark Rosenberg, Top Ten Healthcare Consulting Firms | 5 Comments

ACA – Paved with Good Intentions…

Posted on October 10, 2011 by Kathleen Rand
Affordable Care Act Paved with Good Intentions

ACE- Paved with Good Intentions

The idea behind the Affordable Health Care Act (ACA) is noble and true. The implementation may be a bit more complicated. Public opinion has shifted and health care premiums, according to the Kaiser Family Foundation, have already risen – an increase of 9% over last year, or as Politico stated: as much as a new car.

Yet, the White House is still claiming the law will lower premiums. From http://www.whitehouse.gov/: “Independent experts have found that the new law helps reduce costs for families and businesses, cuts the deficit and strengthens Medicare, adding years to the trust fund while maintaining seniors guaranteed benefits.”

That is not the reality at this point. And when you consider the $500 billion cut from Medicare, you have to wonder: what’s going on?

First, there are expensive requirements of the ACA that have already taken effect. However, the key provisions – the ones that the supporters claim will drive costs down – do not become effective until 2014. Some of these include coverage for young adults 26 years old and under, accepting patients with no pre-conditions, and abolishing annual caps.

Again, good ideas that potentially can provide some long term benefit but three years is a long way off. Furthermore, Health and Human Services Secretary Kathleen Sebelius instituted a rule that would permit the administration the ability to “establish procedures for federal and state insurance experts to scrutinize premiums” starting in September of this year. Managed care companies were told they would have to justify any rate increases above 10%. The Sebelius rule allows HHS to question any insurance agency about its paperwork.

Coincidentally, the Kaiser study showed that premium increases came in at 9% since the passage of the ACA – just under 10%.

Insurers have pushed up costs for many reasons – for instance, the anticipation of an influx of new and possibly sick patients and also to avoid getting audited by the Obama administration before the review period kicks in.

If insurers are required to cover patients regardless of pre-conditions and the number of healthy people who sign up for the exchanges decrease, services will have to be cut in order to make a profit, affecting quality of and access to care.

So, premiums are going up, despite what the White House claims. This is bad for businesses; many won’t be able to afford to cover you or your co-workers, calling into question the President’s claim you can keep your doctor.

As former Democratic National Committee Chairman Howard Dean: “Most small businesses are not going to be in the health insurance business anymore after this thing goes into effect… That’s going to be the biggest boost to small business that has been done in years and years and years.”

Well, actually, the cost of private insurance will be moved onto the public balance sheet, making the cost of the ACA bigger, and letting

Affordable Care Act- a Long Hard Road

ACA- A Long, Hard Road

the taxpayers – including many of those small business owners – foot the bill.

Though the President has claimed that the ACA would bring down costs, grow jobs and help maintain the best care possible by expanding access, its consequences have not quite synced up with the expectations, not exactly what was imagined. And with the Supreme Court involved as well as the many lawsuits filed by individual states, it appears healthcare reform –whether you believe it to be ‘historic legislation’ or ‘socialized medicine,’ promises to be a long, hard road.

 


Posted in Health Care Reform | Tagged Affordable Care Act, Health and Human Services, Health Care Reform, Healthcare Fraud and Abuse, Healthcare Insurance, Healthcare Reform | 7 Comments

The Affordable Care Act – The Communication Obstacle

Posted on October 6, 2011 by Kathleen Rand

Over the next three years, as part of the ongoing healthcare reform initiative the Affordable Care Act (ACA) will be rolled out. As this

Communication Obstacles in healthcare reform

Affordable Care Act- Obstacles

unfolds, America’s state and local officials will then be charged with responsibility of reaching out to more than 30 million individuals in order to enroll them in publicly funded or subsidized health plans. These plans will be offered through state insurance exchanges.

Unfortunately, the majority of those individuals have very little knowledge of health coverage and will have difficulty finding, understanding, and using the insurance information that is necessary to getting properly enrolled.

Failure to meet the enrollment goals, however, will undermine the success of the new health law, and, more importantly, will not increase health insurance coverage. Steps need to be taken to clear up the language and procedures surrounding the enrollment process. Otherwise individuals will more than likely not enroll. A roadblock which will amount to a significant waste of time, energy, and taxpayer dollars.

Properly enrolling in a health insurance plan, particularly a government funded or subsidized plan (such as Medicare or Medicaid), is a complicated undertaking. Individuals must find their way through a maze filled with eligibility guidelines, forms to complete, and lists of mandatory citizenship and financial documentation required for enrollment. Needless to say, if the information is not clear and usable, people will get lost and stalemated.

Additionally, they need to understand concepts such as premiums, co-pays, and benefits, and then apply this comprehension to their existing health situation so that they can choose the most appropriate plan. In short, they must figure out which services are covered and which are not, and complete additional paperwork to enroll in a plan they select.

My head’s spinning just thinking about it. And research proves an even larger issue: Fourteen percent of US adults have trouble finding the date of a physician’s visit on an appointment slip. According to the National Assessment of Adult Literacy, only 12 percent can successfully compute their contribution toward health insurance costs, even when a table is included to facilitate the analysis.

Clear communication is the only hope for the success of the Affordable Care Act to enroll those newly eligible in an appropriate insurance plan. We cannot rely upon a website and assistance from insurance exchange counselors alone. These insurance counselors themselves have to be fully articulate in the language and literacy barriers facing many of those individuals now able to obtain coverage. Even now, state Medicaid programs do not successfully enroll all eligible populations. 88 percent state enrollment is considered highly successful, while the least successful states enroll just 44 percent of those who qualify for services.

The Affordable Care Act does require health plans that are seeking certification in state exchanges to provide information in plain language. This means, according to the ACA, using “language that the intended audience, including individuals with limited English proficiency, can readily understand and use because that language is concise, well-organized, and follows other best practices.”

But is this a reality? One obvious obstacle is the up-front expense of creating insurance information and enrollment processes that use clear, accessible language. However, not making the enrollment process understandable to people of all literacy levels will be even more costly.

A system that is difficult to figure out equals delays in enrollment or failure to enroll at all in any health plan, particularly individuals who are healthy and feel less pressure to have insurance coverage. If these individuals remain un-enrolled, the majority of the individuals participating in the exchange market will be sicker (or higher risk), resulting in higher costs for health care overall.

Proactive measures need to be taken to support individuals through the enrollment process. Assistance with completing the application can be provided by community-based organizations and health providers as well as by the exchange counselors. Low health literacy has to be considered a factor in healthcare reform and actions to eradicate it have to be in place for the Affordable Care Act not to fall short of expectations.


Posted in Health Care Reform, Health Insurance | Tagged Affordable Care Act, Certified in Healthcare Compliance, Compliance Healthcare, Compliance in Healthcare, Health Care Reform, Health Insurance, Healthcare Fraud and Abuse, Healthcare Reform | 13 Comments

USA Today Predicts Fraud Prosecutions to Rise by 85%

Posted on September 1, 2011 by Danyell Jones

Kelly Kennedy a reporter for USA Today recently wrote a story about healthcare fraud and abuse, and shared a staggering statistic, according to government statistics “federal health care fraud prosecution in the first eight months of 2011 are on pace to rise 85% over last year”

To read the full article please click here

What is causing this dramatic increase?  The Obama administrations ramped up fraud enforcement and economic recoupment efforts which are being banked on as a way to pay for Obamas proposed Health Care Reform plans.

According to the article, statistics which were harvested and released by the Transactional Records Access Clearinghouse (TRAC) show that prosecutions went from 731 people in 2010 to 903 people so far in 2011.  Furthermore “prosecutions have gone up 71% from five years ago, according to TRAC.”

USA Today Fraud Statistics

With such an emphasis on recoupment from both a fraud and abuse perspective, and a RAC audit perspective it will become more important than ever that organizations are aware of all of the new laws and regulations which are being released, and that they have a healthcare compliance program in place to mitigate any risk to their organization.

The key is preparation…..so make sure that your organization is ready.  If you are not sure if you have a solid healthcare compliance program, BHM can help.  Just give us a call at 1-888-831-1171 to set up your free initial consultation.


Posted in Compliance, Health Care Reform, Healthcare Fraud and Abuse | Tagged Health Care Reform, Healthcare Compliance, Healthcare Fraud, Healthcare Fraud and Abuse, Healthcare Reform, Medicaid Fraud | 10 Comments

HIPAA 5010 Will Pack a Punch- National Testing Week

Posted on August 25, 2011 by Danyell Jones

Reform, reform, reform…we hear about it all the time, but few organizations know to what extent it will impact their organizations, and

HIPAA 5010

HIPAA 5010 Readiness

even fewer are adequately prepared for changes which are coming down the pike.  HIPAA 5010 is one of those changes which promises to pack a big punch as far as organizations and providers are concerned.  HIPAA 5010 will constitute a large change in the way that providers submit claims, as well as the processes for billing procedures….and its implementation is slated to take effect on Jan. 1, 2012.

What is HIPAA

HIPAA, generally speaking, provides federal protections for personal health information held by health plans, health care clearinghouses, and health care providers.  HIPAA also gives rights to patients/consumers with respect to that protected information.  The U.S. Dept. of Health and Human Services (HHS) also specifies a number of regulations regarding confidentiality, integrity, and availability of this personal health information with regard to electronic medical records

HIPAA 5010- What is the Difference

HIPAA 5010 is more specific in terms of data requirements collected and transmitted with personal health information.  Many of the new requirements deal with a patients location of residence, or address issues.  The mandate will impact how companies, billing providers, and facilities treat postal addresses (for instance PO Boxes are prohibited as a valid billing address, and ZIP codes will be required in their entirety meaning 9 digits, rather than 5).

Who Needs to Be Prepared

As stated, all healthcare organizations will need to be HIPAA 5010 compliant by Jan. 2010, however IT vendors and Data Quality Software Vendors who sell programs to healthcare organizations will also need to be compliant with these changes.  In fact initial surveys point to the fact that healthcare providers are largely leaving the compliance issue up to their outside vendors, counting on them to ensure that all software is able to be updated and ready for the healthcare compliance changes to come, but relying on these vendors could mean potential problems for organizations down the road.

Troubling Statistics

The following information is courtesy of a recent HIMSS survey conducted in Summer 2011

  • 35% of providers stated that they had NO Plans in place to implement a HIPAA 5010 readiness project

How to Prepare

To avoid rejected claims and cash flow interruptions, physicians should prepare for the transition by working with their vendors, clearinghouses, billing services, and payors or upgrade and test their systems and ensure that they are able to successfully implement the new standards prior to the compliance date.

To help practices prepare for the transition, the Centers for Medicare & Medicaid Services (CMS) has announced that Monday, August 22, through Friday, August 26, is National 5010 Testing Week. This is an opportunity for physicians, including their clearinghouse and/or billing service, to test the Version 5010 transactions with the added benefit of real-time help desk support and immediate access to the Medicare Administrative Contractors (MACs). For more information on National 5010 Testing Week, please visit the following link:  5010 Testing Week

For more information on how your organization can be prepared please come back tomorrow, when we will be posting a directory of links for free webinars, HIPAA 5010 blog information, and valuable CMS/HIMSS information.

We look forward to seeing you tomorrow!

 

 


Posted in Compliance, Health Care Reform | Tagged Certified in Healthcare Compliance, Compliance in Healthcare, Health Care Reform, Healthcare Compliance, Healthcare Compliance Association, Healthcare Reform, HIPAA, HIPAA 5010 | 3 Comments

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