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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