HealthMEDX

Top 5 Rejections Related to HIPAA 5010

I know we have touched on some of these before but I think it's helpful to have this information continually at the forefront. Ken Bradley, with The Daily Practice, has come up with a list of the top 5 rejections:

It has been over two full weeks since HIPAA 5010 became the required transaction standard, and by now many practices are beginning to see how the upgrade’s many changes are impacting claim rejections. For the past couple of weeks, I have been monitoring trends in claim rejections—specifically looking at ones that are directly related to 5010. As can be expected, there was an uptick in a number claim rejections. Within all of these rejections, five specific ones caught my eye because each one could easily be corrected so practices can avoid such rejections in the future. Here is a quick look at these five rejections and how to prevent them:

1. No Medicare Secondary Payer (MSP) reason code on a primary claim. In Version 4010, claims only required MSP on secondary claims submitted directly to Medicare. Now, however, healthcare providers must submit an MSP indicator on both the primary and secondary claim when Medicare is reported as the secondary payer. If this information is not included, the claim will be rejected.

2. Lack of drug units when a National Drug Code (NDC) is present. A drug quantity and unit of measurement are required whenever an NDC is listed on a claim. Some clearinghouses and technology vendors will proactively reject claims that have an NDC but don’t have the drug quantity and unit of measurement.

3. No detailed description of an unlisted service. Now in 5010, any claim using an unlisted Current Procedural Terminology (CPT) or HCPCS code must also include the code descriptor or payers will reject the claim. Make sure to work with coders and practice staff to make sure this level of description is used for unlisted codes because this was not required in 4010.

4. ZIP codes are only 5 digits. Addresses for both facilities and billing providers now require a nine-digit ZIP code—this is a distinct change from Version 4010, where only the five-digit ZIP code was required. If you don’t know your nine-digit code, contact your local Post Office or visit www.usps.com. Once you have it, incorporate it into all claims—if needed, reach out to your clearinghouse or practice management vendor to ensure this information is correctly incorporated into your system.

5. Billing provider address is a PO Box. In Version 4010, practices could use a PO Box address for the billing location. With 5010, the bill to address must be a physical street address rather than a PO Box or lock box address. Before making any changes to claims, your practice should verify its address information in the National Plan and Provider Enumeration System (NPPES) to ensure address information is up-to‐date and accurately reflects your actual street address.

If your practice does not use a PO Box or lock box, you do not need to worry or make any changes. Changing the way you submit your street address is ONLY necessary if you are currently using a PO Box or lock box address on claims. If your practice uses one of these for your billing address, contact your clearinghouse or practice management vendor to work through this issue.

Although these five codes are causing issues for many practices around the nation, they are not the only rejection reasons that have been on the rise over the last few weeks because of 5010. The transition to HIPAA 5010 definitely has had some hiccups, but with some due diligence practices can easily overcome these issues. We recommend monitoring and tracking your claims rejections and denials carefully over the next few months. If you notice any unusual trends, be sure to contact your clearinghouse or practice management vendor to uncover the reason for the issues and determine how to prevent them moving forward.

Let ICD-10 implementation and Meaningful Use work with each other

By Carl Natale, ICD10 Watch-  Now that it's 2012, and you have reached HIPAA 5010 compliance, it's time to work on your electronic health record (EHR) and Meaningful Use initiatives. Or do you need to start ICD-10 implementation next?

Lessons Learned during CCHIT Certification

By Beth Ann Muthig, Product Analyst for HealthMEDX  

By now you have heard the wonderful news that HealthMEDX Version 7.1.10 has received Full Product Certification by the Certification Commission for Health Information Technology (CCHIT) and for components for the ONC-ATCB 2011/2012 Certification of both eligible provider and hospital.  The criteria support the Stage 1 meaningful use measures requirement to qualify eligible providers and hospitals for funding.  This funding is not currently available for post acute care. 

About three years ago, my boss said, “We have this project for you, you will love it; it will only take about one year and only about 15 % of your time, a walk in the park”.   Well, it has been more like hiking the Appalachian Trail, which can be done by one person but much more rewarding surrounded by a great group of hikers!

Let me tell you about our trailblazers and the human side of our successful certification process.   Certification was much more than just one team effort to prepare for this process; it was an effort that involves everyone who “touches” our product:  every Vision user, every HealthMEDX employee and our Certification Managers from CCHIT   played a role in bringing this project to such a successful conclusion.  It was more than two years in the making, more than 5200 development hours, and more than 1400 hours of review, testing and dress rehearsals for the actual days of testing.  I had the pleasure of shepherding HealthMEDX through the certification process from the early planning stages to post inspection with our wonderful team.  It was certainly a life challenging event.  One of my proudest moments was our day of actual testing; our core team of presenters was absolutely on script and made us all very proud at HealthMEDX to be represented by such fine individuals.   

What were our top 10 lessons learned through this process?

1.  Take the process very seriously- it is not easy.  Every round of CCHIT certification criteria, every NIST procedure for meaningful use bore close watching; every iteration had some material change that created a new development requirement.  Some were minor tweaks, some required major rewrite of a component of our product, and some required new functionality that did not exist two years ago.
2. Take opportunities to educate.  We continue to educate the acute care world on terminology and concepts used in the post acute world, from concepts of integrated product line that serve both the needs of a continuing care retirement community with both home health and skilled nursing, to simple terms such as problem list in acute world is called diagnosis list in the post acute world. 
3. Security testing is demanding. The security and interoperability were some of the more rigorous aspects of certification from documenting all the detail we use to protect data in transit to demonstration.  Clinical team members went from knowing how your heart works to knowing how to generate encryption hashes! 
4. Read the fine print.  Testing procedures and interpretation of these testing procedures was critical; this impacted the dress rehearsals on our perceptions that we were showing the product correctly.
5. Spend your time wisely.  Time management of all the individuals contributing to the project was extremely important to allow timely follow up on specific expectations during this incredibly challenging project. 
6. Educate on the fine print.  Detailed training guides with the new functionality were critical to the end user including rational for including in the new functionalities, such as Medication Reconciliation and the Continuity of Care Document.
7. Rehearse! Dress rehearsal after dress rehearsals set the stage for a seamless test script execution with CCHIT both for CCHIT certification and Meaningful Use.  Being a web-based desktop sharing application with the jurors was something needed practice because there would be no human eye contact to know how we were doing. Often we continued test scripts without any response from jurors. 
8. CCHIT Staff were always there. Responsiveness and the willingness of the staff at CCHIT to engage with us, to get questions answered, and their patience made the process so successful.
9. Keys:  Patience, dedication and professionalism were the winning combination. 
10.  Deep Breath and get ready for 2013/2014 Testing!

 

HealthMEDX Vision Obtains Full CCHIT Certified® 2011 LTPAC Status

HealthMEDX’ electronic health record (EHR) HealthMEDX Vision version 7.1.10 has passed Certification Commission for Health Information Technology (CCHIT^®) long term post-acute care (LTPAC) inspection, and is a  CCHIT Certified® 2011 LTPAC EHR with additional certification for both the Skilled Nursing Facility and Home Health.

HealthMEDX has completed the full certification process including verification of implementation at client sites.   “Completing the full certification of HealthMEDX Vision was a top priority across our organization” stated Dan Cobb, Chief Technology Officer at HealthMEDX.  “This has been an important focus for HealthMEDX and one we have plans to keep up with as new certification criteria become available in the future.”

This certification has been achieved not long after HealthMEDX Vision 7.1.10 received ONC-ATCB 2011/2012 certification.  Details on this certification can be found at http://www.cchit.org/products/2011-2012/arrafinalruleeligibleprovider/3419.

Read the official announcement here.

Care Area Assessments Review Guidelines for Long Term Care

The National Guideline Clearinghouse has updated the guideline summaries for the following guidelines from the American Medical Directors Association, which may assist you to help facilitate the Care Area Assessments (CAAs) review:

• Altered nutrional status in the long-term care setting. This updates a previously published guideline summary.
  
• COPD management in the long-term care setting. This update a previously published guideline summary.
• Heart failure in the long-term care setting. This updates a previously published guideline summary.
  
• Parkinson's disease. This updates a previously published guideline summary.
• Transitions of care in the long-term continuum.
• Urinary incontinence. This updates a previously published guideline summary. 

A new report, Effectiveness of Early Diagnosis, Prevention, and Treatment of Clostridium difficile Infection, examines current evidence for C. difficile diagnosis, treatment, and prevention methods. The report finds that the standard antibiotic treatments—oral vancomycin, metronidazole, and the newly approved fidaxomicin—are equally effective for curing initial C. difficile infections. However, recurrence of C. difficile infections was found to be less frequent for those who used fidaxomicin rather than vancomycin. Clostridium difficile is a dangerous healthcare-associated infection and a growing health care problem, especially among older adults and those with weakened immune systems. The report is accompanied by clinician and consumer summaries, as well as a CME activity and faculty slides for clinicians.

HealthMEDX Passes SSAE 16 Type II Review

January 10, 2012 The HealthMEDX Data Center for cloud computing clients has passed stringent Statement on Standards for Attestation Engagements (SSAE) No. 16 auditing standards providing increases assurance that patient and resident data managed by HealthMEDX is secure.

The HealthMEDX cloud computing model allows clients to focus on patient and resident care by freeing up critical resources from information technology management.  Client’s databases are maintained and accessed easily through the secure and reliable HealthMEDX cloud.  HealthMEDX recently completed the audit process to ensure the organization’s data center and hosting operations meet the SSAE 16 guidelines.  SSAE 16 effectively replaces SAS 70 as the authoritative guidance for reporting on service organizations.  These updated examination guidelines mirror new international reporting standards. 

Chris Bingham, Vice President of Infrastructure for HealthMEDX, talks about what it means for clients. In addition, there is a link to what SSAE 16 means for the information technology industry. To read the entire article, click here.

HealthMEDX's VisionReceives ONC-ATCB 2011/2012 Certification

January 4, 2012 – HealthMEDX announced today that HealthMEDX Vision 7.1.10, is 2011/2012 compliant and was certified as an EHR Module on January 3, 2012 by the Certification Commission for Health Information Technology (CCHIT®), an ONC-ATCB, in accordance with the applicable Hospital certification criteria adopted by the Secretary of Health and Human Services. HealthMEDX Vision 7.1.10 was also certified as an EHR Module in accordance with the applicable Eligible Provider certification criteria.  The 2011/2012 criteria support the Stage 1 meaningful use measures required to qualify eligible providers and hospitals for funding under the American Recovery and Reinvestment Act (ARRA). 

“This certification was a focus area for HealthMEDX.  We feel these certifications mean a lot for our clients and for our industry” stated Dan Cobb, Chief Technology Officer at HealthMEDX.  “Addressing these types of certification standards is crucial to the success of the organizations utilizing the HealthMEDX Vision solution.”

You can read the entire press release here, which includes all the certification criteria that HealtMEDX Vision, Version 7.1.10 meets.

HIPAA 5010: 10 Tips To Be Sure You’re Compliant

With January 1 only days away, hopefully you have upgraded your software, revised your templates and educated yourself on the 5010 changes. Even if you feel you have everything covered, now is the time to double check the details. Eventhough you have a 90 day grace period it is essential that you find out now if their are holes in your process.

Here are some pointers from Power Your Practice:

1. Make Sure You’re the Billing Provider
Under 5010 standards, the company or organization who provides the billable service is the one that should be listed as the billing provider – not the clearinghouse or billing company.

2. Check That Address
To be HIPAA 5010 compliant, all transactions must include the actual street addresses of the service facility and billing provider, plus their complete 9-digit zip codes. PO boxes are no longer acceptable.

3. Be Consistent With Your NPI
If you’re not reporting under the same National Provider Identifier to all of your payers, you’re not 5010 compliant. Identify your official NPI and make sure you use it in every transaction.

4. Mark the Minutes
All anesthesia services must be reported in minutes, not units, under HIPAA 5010. If “units” remain on your anesthesia forms, update them ASAP.

5. Consult With Your Trading Partners
Don’t assume everyone’s ready to receive 5010 transactions. Find out if one of your payers or clearinghouses is using CMS’ non-enforcement window as an excuse to wait until March to upgrade their systems.

6. Remember the Diagnosis Code
It may have been rare that you sent a claim without one, but it’s worth reminding your coders: Under HIPAA 5010, every single claim must contain a diagnosis code.

7. Double-check: Subscriber/Patient
The individual who has a unique member identifier from your payer is the one you must list as the subscriber in your transactions. If the policyholder is the patient, list him only as subscriber – leave “patient” blank. If a dependent is your patient, list the policyholder as the subscriber and the dependent as the patient.

8. Check for Your Tax ID
The billing provider’s tax ID is required on all 5010 claims. Since the care provider is now always the billing provider, be sure you’re putting your practice’s tax ID on your transactions.

9. Review How Many Codes Point to Your Service Line
HIPAA 5010 increases the number of diagnosis codes allowable on a claim from eight to twelve, but only a maximum of four of those codes can be linked to a service at the service line level. Should a service relate to more than four of your patient’s diagnoses, point to no more than four of them when billing that service line.

10. Get Validation of Your Compliance
If you have any doubts about the HIPAA 5010 compliance of your transactions, get in touch with a validation service. They’ll confirm whether you’re following implementation guidelines and may be able to help you make last-minute changes to your forms or processes.

After reading these, how ready are you for the HIPAA 5010 coversion deadline?

Early EMR adopters get a break; tougher criteria delayed to 2014

By Charles Fiegl, amednews staff. Posted Dec. 12, 2011.

Washington -- Physicians meeting criteria in 2011 to earn federal electronic medical record incentives will havemore time before the Dept. of Health and Human Services requires them to satisfy tougher standards for attaining additional bonuses.

The move is being viewed by physicians and health policy observers as a goodwill gesture by the Obama administration toward EMR early adopters. Doctors and hospitals who currently meet stage 1 meaningful use criteria would be able to vie for bonuses for an extra year under the same requirements, HHS Secretary Kathleen Sebelius announced on Nov. 30. These bonus recipients would not need to upgrade their EMR systems to comply with stage 2 standards until 2014, instead of 2013 under the initial plan.

The delay of stage 2 affects only physicians and hospitals who met stage 1 criteria in 2011. Doctors who will report meeting stage 1 requirements for the first time in 2012 will still be expected to meet stage 2 requirements starting in 2014. Before the new policy change, those who waited until 2012 to adopt would have had a later upgrade deadline but still would have been eligible to receive the same total bonus amounts as the early adopters.

Oct. 3 was the last day a physician could begin a 90-day reporting period for 2011, according to the Centers for Medicare & Medicaid Services. Physicians who met the requirements will have until Feb. 29, 2012, to register and attest to receive a bonus for 2011. Physicians can earn up to $44,000 over five years from the Medicare program or up to $63,750 over six years from Medicaid.

The American Medical Association applauded HHS for adding more flexibility to the incentive program by delaying stage 2. "We continue to urge HHS to fully evaluate stage 1 and develop solutions to increase physician participation rates prior to finalizing requirements for stage 2," said Steven J. Stack, MD, chair-elect of the AMA Board of Trustees.

Organized medicine groups have said that early proposals for requirements under the second phase of the EMR bonus program, if adopted, could dissuade physicians from using EMRs.

In a February letter, the AMA and 38 other organizations urged HHS to make the proposed requirements less rigorous and burdensome. For instance, physicians would need to use an electronic note system and ensure patient access to record portals under stage 2, a mandate many consider difficult to attain.

Public health studies have shown that more doctors want to participate in the EMR adoption program. A study from the Centers for Disease Control and Prevention found 52% of office-based physicians plan to register and attest to meeting program requirements for 2011, which is an increase from the 41% who planned in 2010 to do so. The total portion of physicians who have adopted EMRs also is at 34% in 2011, up from 17% in 2008.

"We are pleased that recent data show there is a high interest among physicians to take advantage of the available incentive payments through the government's [electronic health record] incentive program, but we remain concerned that this increase in EHR adoption will not occur unless the program maintains sufficient flexibility in later stages," Dr. Stack said.

Sebelius spoke about the EMR program and the CDC report during a forum held at Cuyahoga Community College in Cleveland on Nov. 30. The incentive program was created by the 2009 economic stimulus package. Since then, 50,000 new health information technology jobs have been created, she said.

Sebelius said the changes made by HHS would make it easier for physicians to earn incentives and hopefully create more jobs.

"When doctors and hospitals use health IT, patients get better care and we save money," she said. "We're making great progress, but we can't wait to do more. Too many doctors and hospitals are still using the same recordkeeping technology as Hippocrates."

Spurring EMR adoption

The announcement did not surprise those following the program, said Robert Tennant, senior policy adviser for the Medical Group Management Assn. The delay had the support of HHS National Coordinator for Health Information Technology Farzad Mostashari, MD, and was recommended by the office's Health IT Policy Committee in June.

EMR vendors, hospitals and physicians had opposed the 2013 stage 2 deadline for early adopters, the policy committee said in its recommendation. The stage 2 requirements are expected to be finalized in June 2012. That timeline would have given vendors only a few months to design, develop, test and release new products and upgrades before the beginning of the 2013 reporting period in October 2012. Doctors and hospitals also would have been expected to learn new system functionality and reporting requirements quickly.

To read the entire article, click here.

 

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Update from CMS on HIPAA 5010

CMS announced November 17, 2011, that it would not initiate enforcement action with respect to any Health Insurance Portability and Accountability Act (HIPAA)-covered entity that is non-compliant with the ASC X12 Version 5010 (Version 5010), NCPDP Telecom D.0 (NCPDP D.0) and NCPDP Medicaid Subrogation 3.0 (NCPDP 3.0) standards until 90 days after the January 1, 2012, compliance date. Notwithstanding CMS’ discretionary application of its enforcement authority, the compliance date for use of these new standards remains January 1, 2012. The announcement can be found at here .

What the 90-Day Enforcement Discretionary Period Means for

Medicare Fee-for-Service (FFS)

Medicare FFS has experienced significant increases in 5010 production transactions during the last few months. However, there are many submitters that have tested but not taken the step to move into production for 5010 and D.0. In addition, there are many submitters that have not yet initiated testing with their Medicare Administrative Contractor (MAC).Therefore, to ensure that progress continues to be made; Medicare FFS is planning to take the following steps for submitters and receivers of Medicare Part B and Durable Medical Equipment (DME) transactions. Submitters and receivers of Medicare Part A transactions will follow the same action plan starting 30 days after Part B and DME:

• In December 2011, submitters/receivers that have tested and been approved for 5010/D.0 will be notified that they have 30 days to cut over to the 5010/D.0 versions.
• Submitters/receivers that have not yet tested will be notified in December 2011 that they must submit their transition plan and timeline to their MAC in 30 days.
• MACs will notify the submitters/receivers; submitters/receivers have the responsibility to notify the providers they service.

For more information on ASCX12 Version 5010, NCPDP D.0 and NCPDP 3.0, please visit http://www.cms.gov/Versions5010andD0.