nchica 5010 final
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NCHICACommentsonNPRMfor5010TheNorthCarolinaHealthcareInformationandCommunicationsAlliance,Inc(NCHICA)issubmittingthe
commentscontainedinthisdocumenton45CFRPart162HealthInsuranceReform:ModificationstotheHealthInsurancePortabilityandAccountabilityAct(HIPAA)ElectronicTransactionStandards;ProposedRule. NCHICAisanonprofitconsortiumofnearly200organizationsdedicatedtoimprovinghealthandcarebyacceleratingthe
adoptionofinformationtechnologyandenablingpolicies. ThesecommentswerepreparedbytheNCHICAHIPAA
Transactions,CodeSetsandIdentifiers(TCI)WorkgroupandapprovedbytheNCHICABoardofDirectors. The
workgroupisrepresentedbyhealthcareproviders,healthplansandsoftwarevendorswhosupportNorth
Carolinacoveredentities.
Supportfor5010. TheNCHICATransactions,CodeSetsandIdentifiersWorkgroupsupportsthenamingofthe5010versionoftheASCX12transactionsasthenextHIPAAversion. Weseebothtechnicalandbusinessbenefits
inmovingforwardwith5010:
Tightened,clearsituationalrulesreduceanalysistimeforeveryoneandtheneedforcompanionguides
Improvedeligibilityresponsesandbettersearchoptionsimproveefficiencyforprovidersandreducedphonecallsforbothprovidersandpayers
Detailedclarificationsofcommonlymisunderstoodareassuchascorrectionsandreversals,refundprocessing,
and
recoupments
should
result
in
a
consistent
implementation
of
the
835,
which
is
not
thecasetoday. Incorrectimplementationsofthe835havepreventedprovidersfromswitchingto
electronicpostingaswidelyastheymightotherwise. Good835swouldreducephonecallstopayers,
reduceappealstopayersduetomorecompleteinformation,eliminateunnecessarycustomer
support,andreducethecostofsendingandprocessingpaperremittances.
Thegreatlyimproved278referralandauthorizationtransactionisexpectedtoencouragewiderimplementationandsavelaborcosts
However,werecommendthefollowingmodificationstotheNPRMconcerningimplementation.
1. Startofimplementationperiod. Theimplementationperiodneedstostartwiththeeffectivedateofthefinalruleforthefollowingreasons:
Organizationsneedtimetobudget OnlyhighlevelanalysiswasdoneduringtheNPRMcommentperiod,notdetailedsystemsanalysis Vendorswantassurancethatthisistheversionthatwillbeimplemented
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2. StaggeringofcompliancedatesforHITinitiatives. Wesupportthestaggeringofcompliancedatesfor5010/D.0,claimsattachmentsandICD10,butwestronglyrecommendlongerimplementationperiods. The
proposedcompliancedateisnotreasonable. Instead,wesupporttheNCVHSproposalof2yearstogetto
Level1Compliancy(readytotestwithtradingpartners)followedbyatransitionperiod. Discussionatthe
WEDIPAGoffered1yearasatransitionperiod,makingatotalof3years,whichwefindreasonable. The
healthcareindustrycannotbereadyforfullcompliancebyApril1,2010forthefollowingreasons:
ItisapparentthatthetimelinewasbasedonHHSbudgetsandinitiativeswithouttakingtheindustryasawholeintoconsideration. Medicarehasalreadybeenworkingonthe5010project(budgeting,planning,
detailedanalysis)formorethanayear. Therestoftheindustryhasnotstarted,otherthanhighlevel
analysisformakingcomments.
Itisunrealistictobegintheimplementationperiodpriortopublicationofthefinalrule. Ittook4yearstoimplement4010andanother4yearstoimplementNPI,butintruth,neitherisfully
implementedwithinthehealthcareindustry.
ItistruethattheindustryhasmoreexperiencewithHIPAAtransactionsnow,butthesuccessofHIPAAhasresultedinmoretypesoftransactionsbeingconductedwithmoretradingpartners,whichoffsetsthe
gainintimeduetoexperiencebecauseoftheadditionaltesting.
Nopilottestingwasconductedfor5010,sothereisariskthatproblemsapilotwouldhavefoundwillhavetobeaddressedduringimplementation.
Movingto5010involvesmorethanaminorversionupgrade. Itintroducessomenewtechnicalfeatureswhichwillrequirealongerimplementationperiod.
CompetitionforresourceswithotherHITinitiatives.3. Establishmentofatransitionperiod. Westronglyrecommendatransitionperiodforthemovefrom4010A1
to5010foralltradingpartners,asoutlinedintheNCVHSrecommendation. Asinglecutoverdateforthe
entireindustrywillnotwork. Historyhasprovenwiththeimplementationof4010A1andNPIthattransition
periodsarenecessarytofacilitateasmoothimplementationfortheindustry. Toolittletimefor
implementationand
transition
will
necessitate
an
extension,
which
is
very
costly
to
the
industry.
This
would
impactourabilitytoimplementICD10,becausethesameITresourceswillhavetoaddresstheproblems
causedbyahastyimplementationof5010.
Testingshouldbedonewitheachtradingpartner. Everyscenariocannotbecoveredinlowvolumetesting.Someproblemsarenotdetecteduntilendtoendtestingwithhighervolumes.
Atransitionperiodisneededtoensureuninterruptedpayments. Paymentdisruptioncouldhaveanadverseeffectonpatientcare. Conductingrolloutstradingpartnerbytradingpartnerallowspayment
problemstobeuncoveredandaddressedwithoutimpactingallpartnersatonceandjeopardizingcash
flow. Weneedtheflexibilitytouseeither4010A1or5010aswetransitiontofullcompliance. Afterusing
5010in
production,
atrading
partner
may
need
to
switch
back
to
4010A1
while
problems
are
resolved.
Fixingproblemsafterconversionismorecostlythangoodendtoendtestingandincrementalrolloutofnewversionsoftransactions.
Needatimeperiodbeforefinalcompliancedatewhereitiscomplianttouse5010&D.0betweenwillingtradingpartnerswithoutawaiver. Astherulestandsnow,eachentitywouldhavetoapplyforawaiver
toconductanytransactioninthenextHIPAAversion. Definingatransitionperiodwheneitherversionis
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compliantwillsaveCMSandtheindustrytimeandeffort. However,nooneshouldbeforcedtoconduct
5010beforethefinalcompliancedate.
Amoreprudentapproachwillsafeguardtheabilityofthehealthcareindustrytocontinuetoservepatientseffectivelybyensuringthatthereimbursementandtheadministrativetransactionsarethereto
supportsmoothoperations.
Oneimplementationdatemeansthateverycoveredentitywillbetestingandgoinglivewitheverytradingpartneratthesametime. Thiswillcreatetremendousstressontheindustryandmeansthat,if
forno
other
reason
than
limited
resources,
the
time
it
takes
to
resolve
all
issues
will
be
extended.
A
transitionperiodreducesthatandallowsfororderlyplanningoftheseactivities.
Convertingtradingpartnersoveraperiodoftimepreventslengthysystemfreezeswhilewaitingforasingleproductioncutoverdate,allowingdailybusinessoperationchangestooccurasneeded.
4. Considerationofadditionalimpactsonproviders. TheprovidersintheNCHICATransactions,CodeSetsandIdentifiersWorkgroupdisagreewiththestatementthatformanyproviders,5010willbejustasoftware
upgradefromtheirvendors. Followingaresomeotherimpactstoproviders:
Possibleadditionaldatacollectiontodeterminewhetherapatientisuniquelyidentifiedbyamemberid
RevisionofthewayNPIwasimplemented. 5010requiresthatthesamesubpartNPIsbeusedwithallpayers,andsomeproviderschosetoobtainNPIsforusewithasinglepayertoensurepayment. Itwill
benecessarytocoordinatewithalltradingpartnerstoresolvetheissuesandavoidreimbursement
problemsthatrequiredthistypeofNPIimplementation.
5. Adoptionofstreamlinedprocessinfuture. ForfutureadoptionoftransactionsunderHIPAA,NCHICAsupportsthestreamliningoftheprocessaspresentedbytheSDOstoNCVHSonSeptember26,2006. This
wouldshortenimplementationperiodsandallowmorefrequent,regularversionchanges,sothattheindustry
doesnothavetowaitanother10yearstomovetothenextversion. Theindustryneedsregularversion
upgradestosupporttheconstantlychangingbusinessneeds.
6. MonitoringofProgress. CMSshouldmaintainanupdatedCriticalPathMethod(CPM)scheduletotrackimplementationprogresswithpublishedupdateseverysixmonthstoadvisetheindustryifthereisany
slippageonanycomponentoftheschedulethatwillaffecttheoveralltimeline. Thismightbesimilartothe
NCHICAWEDItimelinethatispublishedontheNCHICAwebsiteat:
http://www.nchica.org/HIPAAResources/timeline.htm.
http://www.nchica.org/HIPAAResources/timeline.htmhttp://www.nchica.org/HIPAAResources/timeline.htm
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