Healthcare organizations have a little less than three months to meet the Jan. 1, 2012 deadline for HIPAA 5010 implementation. While CMS reported no major errors during its HIPAA 5010 testing week, hospitals need to ensure vigilance in implementation, as any delays could significantly affect the organization's revenue cycle, putting it at risk for returned or rejected claims. Eric Mueller, president of WPC Services, offers four tips for meeting HIPAA 5010 guidelines.
1. Understand the impact of 5010. "HIPAA 5010 transactions are the mechanisms that support the information exchange that fits underneath the entire revenue cycle," Mr. Mueller says. "All these formats are changing — all the data fields, all the processes that support these [transactions] are changing. It will have an enormous impact to providers' revenue cycle. It's imperative for providers to understand how these changes will affect them." For example, 5010 will affect hospitals' plans for ICD-10 because the HIPAA structure is required for ICD-10.
It is important that not only the hospital C-suite understands the effects of 5010, but also every member in the organization, according to Mr. Mueller. He suggests the CEO talk to employees and physicians about the requirement, asking them questions about the hospital's plans for 5010 so everyone is educated on how the change will impact their responsibilities and workflows. "If someone in the provider space cannot articulate the answer, then there's a problem," he says.
2. Drive accountability. "The provider is ultimately fiscally accountable for [5010]," Mr. Mueller says. The hospital needs to identify where the risks are and manage them accordingly. Accepting responsibility for the success or failure of 5010 means hospital leaders need to provide hospital employees with the tools to manage the risks.
3. Talk to front-line people. Mr. Mueller says hospital executives should speak with the coders and other staff who directly work with coding and claims to understand the system's vulnerabilities. "I would encourage leadership — the CEO, CFO, COO — to get involved. Ask the people who are doing the work, the front-line workers, 'Are we really ready? Are we exposed?', because it's amazing how much information [the front-line workers] will have and provide," he says. Speaking to hospital staff will ensure hospital leaders' perception of 5010 readiness is aligned with actual readiness.
4. Question vendors. Hospitals should talk to their vendors about their plan for 5010 compliance, Mr. Mueller says. "Educate yourself on the changes, specifically the changes that will affect your organization. Don't take anyone else's word for it," he says. For example, if a vendor tells a hospital they have 5010 taken care of, the hospital should question the vendor on how exactly their solution will meet requirements. "Never underestimate the power of the question 'why.' Providers need to ask their vendors why they are doing it this way and not that way," Mr. Mueller says.
He also suggests hospital leaders contact vendors and other partners to determine how they are managing any risks the hospital identified. "Bringing vendors into the discussion to make sure [everyone] has the same interpretation of a problem is very important," he says.
Learn more about WPC Services.
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1. Understand the impact of 5010. "HIPAA 5010 transactions are the mechanisms that support the information exchange that fits underneath the entire revenue cycle," Mr. Mueller says. "All these formats are changing — all the data fields, all the processes that support these [transactions] are changing. It will have an enormous impact to providers' revenue cycle. It's imperative for providers to understand how these changes will affect them." For example, 5010 will affect hospitals' plans for ICD-10 because the HIPAA structure is required for ICD-10.
It is important that not only the hospital C-suite understands the effects of 5010, but also every member in the organization, according to Mr. Mueller. He suggests the CEO talk to employees and physicians about the requirement, asking them questions about the hospital's plans for 5010 so everyone is educated on how the change will impact their responsibilities and workflows. "If someone in the provider space cannot articulate the answer, then there's a problem," he says.
2. Drive accountability. "The provider is ultimately fiscally accountable for [5010]," Mr. Mueller says. The hospital needs to identify where the risks are and manage them accordingly. Accepting responsibility for the success or failure of 5010 means hospital leaders need to provide hospital employees with the tools to manage the risks.
3. Talk to front-line people. Mr. Mueller says hospital executives should speak with the coders and other staff who directly work with coding and claims to understand the system's vulnerabilities. "I would encourage leadership — the CEO, CFO, COO — to get involved. Ask the people who are doing the work, the front-line workers, 'Are we really ready? Are we exposed?', because it's amazing how much information [the front-line workers] will have and provide," he says. Speaking to hospital staff will ensure hospital leaders' perception of 5010 readiness is aligned with actual readiness.
4. Question vendors. Hospitals should talk to their vendors about their plan for 5010 compliance, Mr. Mueller says. "Educate yourself on the changes, specifically the changes that will affect your organization. Don't take anyone else's word for it," he says. For example, if a vendor tells a hospital they have 5010 taken care of, the hospital should question the vendor on how exactly their solution will meet requirements. "Never underestimate the power of the question 'why.' Providers need to ask their vendors why they are doing it this way and not that way," Mr. Mueller says.
He also suggests hospital leaders contact vendors and other partners to determine how they are managing any risks the hospital identified. "Bringing vendors into the discussion to make sure [everyone] has the same interpretation of a problem is very important," he says.
Learn more about WPC Services.
Related Articles on HIPAA 5010:
National Version 5010 Testing Week: The Good and Bad NewsHow to Make Sure Your Hospital is Level II Compliant With Version 5010
Lag in HIPAA 5010 Preparation Does Not Bode Well for ICD-10