HIPAA 5010 and business transformation
Enough has been said and written (some in our own blogs here) about how HIPAA 5010 should be seen as “business transformation”. It’s okay to view it as a transformational program as long as you have the extra money and the time to implement one. If you don’t have either or only one of the two, I’d say stay focused on to the compliance aspect and what I like to call the “tactical opportunities” or the low hanging fruit.
The ground work has been done for you by CMS – just by complying with what CMS is asking of you, you’ll be able to interact with your trading partners using a more standardized transaction format. You’ll end up with less number of partner specific companion guides to maintain and reduced need to create new ones. You’ll also improve your payment cycle and customer service, by carrying out inquiries and responses electronically.
5010 provides you with many new pieces of information you didn’t have in 4010. You can still achieve compliance without processing this information internally, but these are opportunities for you to quickly improve your process efficiency. For example, with 5010 payers will be able to readily determine the additional paperwork available at the physician’s office. You probably need multiple back and forth transactions/phone calls to gather that information currently. Similar changes can be squeezed into your HIPAA 5010 program plan easily, with returns immediately post implementation and you’ll breakeven in the very short term.
Lastly, I’m not saying that no strategic opportunities exist with HIPAA 5010 transition. If you have an ailing front end system that takes a fortune to maintain and is plagued with scalability issues, this is the right opportunity to re-engineer that to a modern scalable platform. In any case, you’ll need to pick your battles wisely. In these days of short supply of money you don’t want to run out of money too soon, more so because ICD-10 is also knocking at your door!
Comments
If reform bill becomes a reality, the knocking at the door will be a group of guests and not just ICD-10.
The degree of changes needed with concepts like Insurance Exchanges and regulations like Medicare type Get-Monitored-Get-Paid schemes with direct involvement of Government, it would be interesting to evaluate risks and rewards.
I have followed Reforms for 4 years now and it is time for IT to really tackle some complexities in these evolving scenarios.
Posted by: Manaw Modi | January 16, 2010 8:27 AM