Clock Ticks Toward HIPAA 5010, ICD-10 Deadlines
There are two ways of looking at upcoming compliance deadlines for HIPAA 5010 and ICD-10, Healthcare IT News reported in March.
Botch the deadlines, and providers will face significant disruptions in their payments. Make the deadlines, and hospitals and physician practices can expect to participate in savings estimated to reach $35 billion industrywide.
“That’s a big number,” said John Casillas, senior vice president of HIMSS Medical Banking Project. “In an era where we need to find pragmatic solutions that deliver value, the nexus of banking and healthcare offers great promise.”
Casillas and others are bullish on the convergence of IT and healthcare financial systems. Although this convergence has been occurring since the early 1980s, industry experts say that government mandates – and the incentives offered by ARRA – have hastened the evolution.
"I call it the 'a-ha moment'," said Pam Matthews, senior director of business and financial information systems at HIMSS. "These developments have connected the dots for all the stakeholders who need to act."
Matthews and Casillas commented in February, but the march toward 5010 conversions and ICD-10 continues today as the deadlines approach.
First up is HIPAA 5010, a move that is likely to require significant changes to software, billing systems and workflows. Providers and most payers have to be ready to begin testing 5010 transactions by Jan. 1, 2011, and are required to submit transactions with 5010 on Jan. 1, 2012.
Next is ICD-10, in both "CM" and "PCS" flavors (for inpatient and ambulatory settings). Providers need to convert from ICD-9 to the appropriate ICD-10 set by Oct. 1, 2013. In this case, the United States is a laggard – most other nations adopted ICD-10 a decade ago.
"The United States put off adopting this – and by putting it off, we've made it harder on ourselves," noted Dan Rode, vice president for policy and government relations with AHIMA – the American Health Information Management Association. "Between 1999 and 2009, we've added a lot more systems to manage healthcare data. Many of these will have to be modified."
What's interesting, these experts agreed, is that whatever you want to call the triggering developments – nexus, convergence or perfect storm – they are creating a new healthcare ecosystem in which teams of stakeholders from various professions and departments are involved: HIM managers, IT departments, revenue cycle and patient accounting, clinical departments and clinicians themselves.
According to a survey by HIMSS, about 60 percent of providers are aware of the ICD10 and 5010 timelines, but only 43 percent had good or average knowledge about the necessary changes. Even fewer had a formal plan in place – just 12 percent of providers have a 5010 plan in the ready; only 9 percent have an ICD-10 plan.
"Meeting the compliance deadlines won't be achieved merely by burning the midnight oil," Matthews warned. "Providers should take a hard look at their organizational priorities – their budgets, their plans... This requires significant strategic, tactical and financial planning."
HealthCare IT News, 12-22-2010