September 28, 2010 – Health information management professionals, and the industry as a whole, face the convergence of complying with several “enormous” regulatory initiatives simultaneously, says Deborah Kohn, principal at Dak Systems Consulting, San Mateo, Calif.
These include the HITECH Act and its meaningful use and enhanced HIPAA privacy/security provisions, conversion to HIPAA 5010 transaction sets and ICD-10 code sets, and the Affordable Care Act (health care reform). But too many health care organizations consider parts of these initiatives, particularly the transaction and coding sets and payment changes under reform, to primarily be a “vendor compliance problem,” Kohn adds.
But vendors will not change internal interfaces and custom reports, she notes. Some vendors may fail to comply with certain initiatives, decide not to comply or not comply in time. And all of these initiatives will substantially change internal functions for organization, particularly workflows and processes with a big effect on revenue cycle management.
That’s why organizations must coordinate compliance initiatives by involving the CIO, CMIO, CMO, and CNO. In addition, leaders of revenue cycle, health information management, case management, quality management, legal and internal auditing, should be involved, Kohn advises. “You must be planning for the convergence of these initiatives and their affect on technology, processes and people.”
Organizations also must be aware of various testing deadlines, particularly with the 5010 transaction sets that have a Jan. 1, 2012, compliance date, says Elaine Lips, president and CEO at ELIPSe Inc., a Los Angeles-based consultancy.
The end of 2010 is a “soft date” for completing internal testing, Lips notes. But external testing with clearinghouses, vendors and insurers must take place during 2011 for the more than 500 changes between the 4010 and 5010 transaction sets. The Centers for Medicare and Medicaid Services counsels it will take two months to test with Medicare and about three months for Medicaid.
Kohn and Lips spoke during the AHIMA Convention & Exhibit in Orlando, Fla.
This originally appeared on Health Data Management.