If you have ever struggled just to get out of town to start a long trip, then you can relate to the challenges facing healthcare payers and providers in implementing HIPAA 5010 and meeting the rapidly approaching deadlines. Citing difficulties with competing healthcare IT projects, HIMSS noted in August that its most recent ICD-10/HIPAA 5010 Provider Readiness Survey showed that most healthcare providers will not be ready to start HIPAA 5010 testing by the recommended date of January 1, 2011. The HIMSS study found that only 38 percent of providers reported having an ongoing HIPAA 5010 initiative, while 35 percent indicated they have no timeline plans for implementing such a project.
While many providers claim to have a roadmap on how to implement HIPAA in another study, the majority of them believe that an upgrade by their software vendor will solve the problem. Such transitions, for both 5010 and ICD-10, will be difficult and complex for the software vendors. Payers, for instance, have hundreds of vendors, many of whom have something to do with HIPAA 5010 or ICD-10 codes, and they have to manage all of them, individually. That same goes for providers. Here is the kicker – whether vendors deliver the updates on time or not, the ultimate responsibility resides with providers and payers. The healthcare providers are at the mercy of the vendors for timing, and the software vendors are not small companies. The payers and providers are ultimately the ones who get the penalty for a non-compliant claim.
Providers or payers facing a software vendor who is not going to make the deadline can take the dramatic approach of switching to another vendor who will meet the deadline or adopting a short term “fix” to inbound and outbound HIPAA 5010 transactions. The solution is to stay compliant through translation of the 4010 to 5010 transactions in both directions. By adopting this approach, the payer or provider can isolate that software application until it meets 5010 or ICD-10 compliance and they can continue operating.
Translation is the approach that would take an inbound HIPAA 5010 transaction, validate it, translate it to a 4010 transaction and send it to the existing software applications for consumption. Conversely, when the existing software applications produced a 4010 transaction, it would be translated to HIPAA 5010, validated and then sent to the trading partner. This step-up, step-down translation approach can help payers or providers that don’t have time for lengthy remediation or competing IT projects – like an EMR implementation meet the deadlines for testing without the big “rip and replace” or anxiety of running multiple large parallel projects.
Another advantage of translation is that as existing software applications become HIPAA 5010 compliant, then simply stop translating – validate, then send or receive. This systematic implementation of HIPAA 5010 allows incremental cut-over of the many software packages in the typical healthcare IT environment and that reduces the time pressure on the journey to ICD-10. Most trips are less stressful, when you can take a leisurely approach and, when in a foreign land, have a translator handy.
To read more about the time-saving translation approach: http://www.edifecs.com/downloads/Edifecs5010-StepUp-StepDown.pdf
