What’s New in Healthcare Regulatory
Did you know that HIPAA 5010 and ICD-10 rulings have impacted close to 80% of most enterprises’ health plans, business processes and systems? The administration has imposed definite deadlines for migration and completion of replacements and HIPAA 5010 involves the adoption of new claims guidelines, eligibility inquiries, payment advice, recommendation or referral authorizations and several other transactions. This migration process espouses a restructured version of the National Council for Prescription Drug Programs (NCPDP) standards and also the Medicaid pharmacy subrogation transaction standards. ICD-10 is the US Department of Health and Human Services (HHS) regulation that is set to replace ICD-9 clinical modification sets. It basically includes the revamping of existing coding systems in all healthcare enterprises. So while the timeline for HIPAA compliance 5010 is Jan 1, 2012, and for ICD-10 it is Oct1, 2013, it actually means that after these deadlines, all electronic claims and services (including medical diagnosis and in-patient procedures) should necessarily use version 5010 and ICD-10 respectively.
Meeting the migration and compliance timelines will require quite a bit of an effort from the healthcare enterprises because they will need to address all reforms successfully and to do that they need to enhance their operational agility to be able to see improved results. The major challenge in meeting all the compliance requirements remains in effective integration between web-based technology and organizational services to further enhance customer experience. Healthcare Enterprises need to initiate with some additional efforts in their overall healthcare compliance plans to comprehensively manage transitions and alleviate all risks away.
From healthcare enterprises, to physicians to pharmacy managers all are required to implement these new standards to be able to make possible the operability between systems and also to ensure total competency at all levels. HIPAA migration requires certain modifications in the way transaction data is collected and conveyed. This means that the eventual data that is to be transmitted needs to made much simpler and understandable. In addition to this, enterprises will also need to classify their aims and their rules connected to any transaction. ICD-10 migration will bring in changes which will include in the augmentation of the no of code sets which goes up from 18000 to 140000 along with an enhanced code size which will now no longer be the standard character length of 5 rather it will be 7, to permit greater quantities of data. Furthermore, this migration will also see structural alterations from the usage of numeric codes to that of the alphanumeric ones.
The new HIPAA 5010 and ICD-10 rulings ensure improved usability and efficacy of transactions which will also include claims, eligibility inquiries and several other transactions. It improves the security of personal medical information and also helps healthcare customers to buy the correct and effective health insurance. It therefore goes without saying that enterprises in the healthcare sector, need to be aware of all that the nuances and intricacies that exists within the healthcare regulatory compliance rules. Hopefully this article has helped in clearing some of the doubts away.
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