Hope for the best, expect denials
Extinguishing any hope that maybe, just maybe, the healthcare realm is somehow more prepared than it appears for HIPAA 5010, at least two vendors publicly stated that they are ready for the EDI mandate in mid-January.
That’s right: after the deadline, and more than a year later than the recommended timelines, practice management and EHR vendor SequelMed publicly announced on Jan. 10 that its software is now HIPAA 5010-compliant. And SequelMed came in ahead of Enhanced Management Services, which issued a statement on Jan. 13, that its ambulance billing services are now in 5010 compliance.
“Most U.S. healthcare organizations, and providers in particular, will still have a challenging start to 2012, because claims submitted in 4010 format can still be rejected,” said Raul Villar, president of ADP AdvancedMD, which provides cloud-based practice management software for small physician groups. “The only thing the 90-day reprieve does is save providers from penalties. If they are not able to submit in 5010, or come up with a step-up, step-down solution to convert, they could run into a lot more denials and revenue issues.”
CMS in November unwrapped an early holiday gift by granting 90 ‘enforcement free’ days during which it will not penalize providers and payers for non-compliance. Healthcare organizations, of course, were still required to comply by the Jan. 1, 2012 deadline. The grace period was generally received as a pragmatic, welcome change so that clearinghouses, providers, and payers have time to iron out the wrinkles.
If healthcare organizations “actually maintain the same urgency and focus they should have had all along,” it will pay off, said Steve Sisko, a technology consultant focused on HIPAA 5010 and ICD-10. “But I'm sure some will take this as an opportunity to slack off.”
Sisko explained that some payers have spent considerable time on 5010, and that “it’s really the providers who are the slackers, and 5010 should largely be handled by most providers billing services not the practice itself like will have to be done for ICD-10.”
ADP AdvancedMD’s Villar explained that during the HIPAA 5010 testing phases, participating health organizations learned that there’s a lot of work to be done.
“When the client gets connected, they might not have the right address, they may not have the right zip code numbers, things that over the past eight or nine years with 4010 payers have accepted, now they won’t be accepting,” Villar said. “So it does require a lot of diligence to make sure all your information is correct and that you’re modifying your current data sets to comply with 5010.
Even that, of course, presumes that health entities have the software update in place. ADP AdvancedMD updated its wares in mid-November, but not all 5010 vendors can maintain the same.
As things get down to the wire, do those providers that are either procrastinating or missing the vendor upgrades actually have time enough to comply by March 31?
“It’s going to be a very messy situation with lots of confusion because the majority of providers and vendors don’t have the ability to modify their technology that quickly and more than likely vendors might make one version of an application 5010-compliant but not update their entire client base,” Villar added.
Professional associations, such as the American Hospital Association, the American Medical Association, the Medical Group Management Association, and others, will be monitoring the HIPAA 5010 transition closely, as it is widely viewed as a pre-cursor to the massive ICD-10 mandate.
“We are watching for the industry transition to HIPAA 5010. Smooth or protracted implementation of 5010 will be a good gauge for how ICD-10 will go,” answered Robert Tennant, senior policy advisor at the MGMA when asked whether MGMA might embark on a quest to cease ICD-10 like the AMA launched in mid-November. “We are in the process of determining the best course of action from an advocacy perspective,” he said.
Sisko shares his take on what would have been a better course of action.
“Frankly I think the meaningful use and eRX should have been delayed until after 5010 plumbing and ICD-10 was delivered,” Sisko said. “The incentives from meaningful use will be nothing compared to the penalties of screwing up 5010 and the cost of not doing ICD-10 on time.”
