Corporate Compliance

Hospital margins in jeopardy as HIPAA 5010, ICD-10 deadlines loom

Compliance Monitor, November 16, 2011

Bruce Landes, MD, president and CEO of Southwest Physician Associates, a 1,500-member IPA in Dallas, has been on a mission—he is trying to get the word out about the potential ramifications of HIPAA 5010 and ICD-10.

Landes has been writing newsletters, contacting media outlets and his colleagues, and hosting a seminar on these topics. He’s also had numerous conversations with peers who says they aren’t prepared for the potential effect of these two transitions on the bottom line. And there’s a lot of money at stake for both the unprepared and the prepared, he warns.

“I think we’re going to have a whole lot of panicked calls in January when the providers suddenly find out their claims process doesn’t work,” he says.

Failure to properly implement t HIPAA 5010 and ICD-10 could lead to potential financial upheaval, including the following:

  • Significant increases in accounts receivable
  • Rapid decreases in cash flow
  • High call volumes due to rejected claims
  • Risk of increased audits and sanctions

HIPAA 5010, the latest version of healthcare transaction standards, focuses on the electronic exchange of administrative and financial information between healthcare providers and health plans for patient care services, including the following:

  • Eligibility inquiries
  • Service (treatment) authorization and referrals
  • Claims status requests
  • Claims and remittance advice (claims payment)

Full implementation by January 1, 2012, is necessary to avoid delays in claims reimbursements.

HIPAA 5010 transactions are a key component of ICD-10, which is the largest overhaul of healthcare codes in the past 30 years. The transition to ICD-10, which will occur October 1, 2013, includes more than 155,000 codes, a significant expansion from the current 17,000 codes in ICD-9.

This article is adapted from a HealthLeaders Media article. Read the original article on the HealthLeaders Media website.

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