Logjam of health IT initiatives could mean delays for HIPAA 5010, ICD-10

Call it Carmageddon: Healthcare Edition.

Last week, Los Angeles shut down a portion of its key 405 artery to broaden the highway, forcing many commuters to stay home. Architects of the road widening promised that traffic would flow much more easily afterward. Similarly, hospitals and physician practices face an unprecedented logjam of new health IT requirements, with "architects" in this space promising that information--instead of cars--will flow much more easily. Everyone--including patients--will be better off, we keep hearing.

The long-term outcome can be debated, but there's no question that healthcare providers are facing their own Carmageddon. In addition to Meaningful Use, which offers a significant potential upside, hospitals and doctors also must contend with the transition to the HIPAA 5010 transaction set in January and, in 2013, the much bigger shift to the ICD-10 diagnostic code set. So it's not surprising that a large percentage of physician groups might not be ready for the 5010 changeover by the end of the year, according to a recent survey by the Medical Group Management Association (MGMA).

Regardless of whether the problem is the providers, the vendors, the payers, or some combination of the three, it's possible that the Centers for Medicare and Medicaid Services (CMS) will have to push back the deadline for 5010, and perhaps for ICD-10, as well.

Will the government blink? Well, Farzad Mostashari, National Coordinator for Health IT, has said he will follow the recommendations of a government advisory committee and postpone the effective date for Stage 2 of Meaningful Use from 2013 to 2014. CMS could very well yield to industry inertia on the administrative transaction and coding changes, as well. That would be a setback, but it also would prevent serious problems, such as delays in provider payments.

Meanwhile, real progress is being made in other areas that will benefit providers with little effort on their part. One example is CMS' adoption of the CAQH CORE operating rules on the electronic exchange of information on insurance eligibility and claims status. Coupled with the private sector's support for these rules, this should streamline the transmission of this information, reducing excess administrative work in practices.

Another promising breakthrough is the upcoming pilot of CMS' "electronic submission of electronic documents" (esMD) program. Starting in August, healthcare providers will be able to send unstructured documents online to CMS in response to requests from Medicare review contractors. Such an approach could save hospitals and doctors up to half of the cost of copying and mailing or faxing these documents to the review contractors, according to NaviNet, a company that connects providers and plans through multi-payer web portals.

NaviNet is one of the private "health information handlers" that CMS has approved to send these clinical documents through use of the CONNECT gateway that also will be used to link systems to the National Health Information Network. The company is planning to use the same software it is deploying to send documents to Medicare for transmitting document attachments to private payers, as well.

Both the CMS document attachment program and the CORE operating rules represent efforts to address the real-world problems that the HIPAA transaction set never solved. If the government continues to grapple with these issues in a realistic way, healthcare's own Carmageddon might actually produce some of its promised benefits--although the transition will be no less painful. - Ken


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