The Background and Impact of the Transactions and Code Sets Rule
May 26, 2009 at 2:00pm EDT
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Surveys of payers and providers have shown a lack of awareness of the background, impact, and the ongoing nature of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Rules the legislation enabled, including the Privacy, Security, and Transactions and Code Sets Rule, as a part of Administrative Simplification. This module is the first in a series designed to give payers and providers a comprehensive understanding of the history and intent of the legislation and impact on overall operations and specific functional areas, information systems, interfaces, processes, workforce competencies, and trading partners, including hospitals and physicians.
Unlike the Privacy and Security Rules, where payers and providers could choose how they would comply, risking civil and criminal penalties, 5010 and ICD-10 require precise compliance to enable claims submission and payment and, ultimately, outcomes-based pay-for-performance and value-based purchasing as a part of national healthcare reform. Compliance, however, is not just about coding or changing field lengths in computer systems. This will require the most massive organization-wide business transformation the industry has ever experienced.
This module clearly outlines the recommended best practices compliance approach and process that should be followed to ensure an effective compliance effort, including Education, Gap Analysis, Implementation Planning/Roadmap, Change Leadership and Business Process Reengineering, and Implementation phases. The time to compliance for payers may be up to four years. This module will include an in-depth understanding of the changes focused on specific operational areas.