HIPAA - Past, Present, and Future
Published: 2009-12-02 06:47:10
Author: Karl Richards | WTN News | November 19, 2009
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) ushered in a new age of modernizing the United States healthcare system. The goal of HIPAA was to simplify healthcare administration to improve efficiency and cost effectiveness. Sound familiar?
Although HIPPA became law in 1996, the legislation did not have a significant impact until 2003 when CMS mandated the use of electronic data interchange (EDI) and established standards for healthcare information privacy and security. HIPAA called for the implementation of ASC X12 standard EDI transactions (Table 1) among healthcare providers, insurers, purchasers, and financial institutions. Consumers felt the impact of HIPAA as mandates took effect that drove significant improvements to the security and privacy of personal healthcare information. More recently, the same HIPAA act brought us a new National Provider Identifier (NPI) system, creating unique identifiers for physicians and healthcare organizations across the United States. With all the progress that the industry has made, outsiders might conclude that healthcare administration simplification is nearing completion, but in fact, the transformation has just begun.
Table 1 - Original HIPAA Electronic Transactions
Introducing HIPAA 5010
Presently the healthcare industry is feverishly working to prepare for the updated EDI standards mandated by the Department of Health and Human Services (DHS) final rules adopted in January 2009. These new rules call for the replacement of the current ASC X12 Version 4010/4010A (medical) and NCPDP Version 5.1 (pharmacy) standards with updated X12 Version 5010 and NCPDP Version D.0 standards, collectively called HIPAA 5010. Table 2 provides an overview of compliance milestones for the new mandates.
Table 2 - HIPAA 5010 Compliance Milestones
The big driver behind HIPAA 5010 is the need to accommodate the new international classification of diseases coding standards version 10 (ICD-10). On January 16, 2009, DHS released the HIPAA Administrative Simplification ICD-10 Final Rule (CMS-0013-F), which requires the healthcare community to adopt ICD-10 by October 1, 2013. ICD-10 is a complete topic on its own, but in summary, the current ICD-9 coding standards, first published in 1977, require significant modifications to meet the needs of our modern healthcare system. HIPAA 5010 is a required first step in ICD-10 adoption, updating the HIPAA EDI transactions to accommodate ICD-10.
A secondary, but important driver for HIPAA 5010 is the recognition that certain functionality in the HIPAA EDI transactions is lacking, which has reduced the effectiveness and full adoption of the transactions. Besides accommodating ICD-10, the new EDI standards will be more specific in requiring the data elements needed, collected, and transmitted with the goal of reducing ambiguities in the transactions. As a result, significant changes will be required to many of the existing HIPAA transactions and more changes are just around the corner.
Full story
Published: 2009-12-02 06:47:10
Author: Karl Richards | WTN News | November 19, 2009
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) ushered in a new age of modernizing the United States healthcare system. The goal of HIPAA was to simplify healthcare administration to improve efficiency and cost effectiveness. Sound familiar?
Although HIPPA became law in 1996, the legislation did not have a significant impact until 2003 when CMS mandated the use of electronic data interchange (EDI) and established standards for healthcare information privacy and security. HIPAA called for the implementation of ASC X12 standard EDI transactions (Table 1) among healthcare providers, insurers, purchasers, and financial institutions. Consumers felt the impact of HIPAA as mandates took effect that drove significant improvements to the security and privacy of personal healthcare information. More recently, the same HIPAA act brought us a new National Provider Identifier (NPI) system, creating unique identifiers for physicians and healthcare organizations across the United States. With all the progress that the industry has made, outsiders might conclude that healthcare administration simplification is nearing completion, but in fact, the transformation has just begun.
Table 1 - Original HIPAA Electronic Transactions
| Transaction Description | ASC X12 Identifier |
| 1. Health claims, encounter information, or coordination of benefits | 837 |
| 2. Health care payment and explanation of benefit remittance advice | 835 |
| 3. Enrollment and disenrollment in a health plan | 834 |
| 4. Health care benefits and eligibility inquiry / response | 270 / 271 |
| 5. Health plan premium payments | 820 |
| 6. Health claim status inquiry / response | 276 / 277 |
| 7. Referral certification and authorization. | 278 |
| 8. EDI Functional Acknowledgement Transaction Set | 997 |
Introducing HIPAA 5010
Presently the healthcare industry is feverishly working to prepare for the updated EDI standards mandated by the Department of Health and Human Services (DHS) final rules adopted in January 2009. These new rules call for the replacement of the current ASC X12 Version 4010/4010A (medical) and NCPDP Version 5.1 (pharmacy) standards with updated X12 Version 5010 and NCPDP Version D.0 standards, collectively called HIPAA 5010. Table 2 provides an overview of compliance milestones for the new mandates.
Table 2 - HIPAA 5010 Compliance Milestones
| Milestone | Description | Compliance Date |
| Effective Date of the regulation |
|
March 17, 2009 |
| Level I Compliance | Demonstrably compliant transactions | December 31, 2010 |
| Level II Compliance | Completed testing with trading partners and in production | December 31, 2011 |
| All covered entities fully compliant | Dual use of new and legacy standards no longer permitted | January 1, 2012 |
The big driver behind HIPAA 5010 is the need to accommodate the new international classification of diseases coding standards version 10 (ICD-10). On January 16, 2009, DHS released the HIPAA Administrative Simplification ICD-10 Final Rule (CMS-0013-F), which requires the healthcare community to adopt ICD-10 by October 1, 2013. ICD-10 is a complete topic on its own, but in summary, the current ICD-9 coding standards, first published in 1977, require significant modifications to meet the needs of our modern healthcare system. HIPAA 5010 is a required first step in ICD-10 adoption, updating the HIPAA EDI transactions to accommodate ICD-10.
A secondary, but important driver for HIPAA 5010 is the recognition that certain functionality in the HIPAA EDI transactions is lacking, which has reduced the effectiveness and full adoption of the transactions. Besides accommodating ICD-10, the new EDI standards will be more specific in requiring the data elements needed, collected, and transmitted with the goal of reducing ambiguities in the transactions. As a result, significant changes will be required to many of the existing HIPAA transactions and more changes are just around the corner.
Full story