Effectively using information technology (IT) to reduce cost and eliminate complexity is a focus of health care reform and health plan compliance. New mandates are an opportunity to drive down cost while improving patient privacy and security, access, and the overall quality of health care delivery using the new HITECH, HIPAA 5010 standards and the richer data set inherent in the International Classification of Diseases (ICD-10) mandated for use in 2013.
Patient privacy and security are at the top of the priority list for health plan and provider executives. Solution and platform providers must address this imperative with "out of the box" capabilities that readily enable healthcare covered entities to meet the mandated physical, technical, and administrative safeguard requirements.
The change to ICD-10 is significant. The complete ICD-10 code set is nearly ten times larger than the ICD-9 code set it is replacing. Further complicating the federally mandated deadline is the fact that before ICD-10 can be put into production, the switch from HIPAA 4010A1 to HIPAA 5010 must be in place. Overall, it's easy to see that the road to reform is littered with complex and costly challenges. But by selecting the right technology, health organizations can smooth the path.
Challenges for health organizations
The increased number of codes and the change in code length, combined with considerably more code specificity, mean the replacement of ICD-9 requires significant planning and system modifications or upgrades, along with training and other investments. Potentially all departments and their support systems in all U.S. health organizations, providers and plans alike, are affected.
Adding to the risk, complexity, and costs is the fact that HIPAA 5010 capabilities are a "must-have" to support ICD-10. On January 1, 2012, the HIPAA standard transactions covering the health claim process, first mandated in 2000, changed version. The original version does not accommodate ICD-10.
In light of these new regulations and to ensure minimal disruption to revenue cycles and payment flow, providers and health plans face numerous challenges, including the need to:
Enable compliance while driving business process, automation, simplification, and self-service
Business owners require an strong technical foundation so innovation flourishes
Manual workflow prevents operations and IT from planning their long- and short-term strategies
Information workers need to be self-sufficient, thus reducing their reliance on IT for everyday needs.
Reduce dependency on legacy mainframe systems to lower IT and administrative costs
Costs to maintain and support legacy systems are increasing.
Legacy systems do not provide business owners with the flexible platform required to advance solutions, leading to redundant systems.
Healthcare systems require agile, flexible environments that allow data to flow without friction.
Integrate new and old technologies regardless of data formats
The only constant: Nothing is constant. Health environments are complex and as technology evolves, organizations can't replace multiple systems at the same time.
Business operations must not stop — new and old must run side by side for a period of time. Transitioning from ICD-9 to ICD-10, HIPAA 4010A1 to HIPAA 5010, an old electronic medical records system to a new EMR system — all require tandem processing and must not affect clinical, claim, or payment flow.
Meeting these challenges with Microsoft Server platform
Microsoft BizTalk Server 2010, coupled with other platform technologies such as Microsoft SQL Server 2008 and Microsoft Office SharePoint Server 2010, enables health organizations to simplify their solution infrastructure and reduce costs by leveraging the platform's "in the box" capabilities, partner resources, and best practices. The Microsoft platform provides:
Native support for HIPAA 5010 to meet the mandate
HIPAA mandated the use of Accredited Standards Committee X12's 4010 version in 2000. The new mandate, which took effect on January 1, 2012, is for X12 version 5010. HIPAA 5010 messaging schemas, trading partner management, and integration components are included with BizTalk Server at no additional cost.
Straightforward ICD-10 compliance to keep mission-critical systems going
Once HIPAA 5010 is in production, ICD-10 is easily sent and received in time for the October 1, 2013, deadline.
Leverage of existing IT investments to save money
BizTalk Server 2010 inherently integrates with the entire suite of Microsoft tools and interoperates with legacy applications and Java-based platforms. Application adapters and toolkits are also included with BizTalk Server 2010 at no additional cost.
Health plan compliance: Getting started
The US government mandate to transition to HIPAA 5010 and ICD-10 presents a unique, time-sensitive opportunity for health organizations. Health payers and providers should act now to define their goals, assess their current state, and plan for change, then build, test, and deploy new solutions taking advantage of this critical opportunity.