Welcome to Financial Edge

Thank you for subscribing to Financial Edge, HIMSS’ financial systems eNewsletter—your source for the latest issues and emerging trends focused on financial systems and related technologies within healthcare delivery.

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Story ideas and other comments can be emailed to Nancy Vitucci, Manager, Publications.

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Still Time to Register for HIMSS09

There is still time to register for the 2009 Annual HIMSS Conference and Exhibition—the industry’s biggest event, April 4-8 in Chicago. Registration is open now and remains open throughout conference. Late-registration/on-site rates now apply. HIMSS09 registration includes entrance to keynote presentations, education sessions and the exhibit hall, Sunday, April 5, through Wednesday, April 8; the opening reception; CD-ROM conference proceedings; and a registration tote bag and kit (while supplies last). Air travel and hotel information is available on the HIMSS09 Web site. In addition to making reservations online, attendees can contact Ambassadors, HIMSS’ official housing and travel bureau at 877-517-3038.

Visit the HIMSS09 Web site for more details on education, the exhibition, networking events and more. Education offerings examining today’s evolving healthcare finance market include the Financial Systems and Payer Symposia, Price and Quality Reporting Roundtable and Business and Financial Systems Track.

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Healthcare Organizations Collaborate to Test HIPAA Transactions against Proposed 5010 Standards at Interoperability Showcase at HIMSS09

CAQH, HIMSS, the Integrating the Healthcare Enterprise (IHE) Initiative, and the Blue Cross and Blue Shield Association (BCBSA) are collaborating with the Centers for Medicare and Medicaid Services (CMS) on the formation of a 5010 Testing Project to address real-time testing of the new X12 HIPAA 5010 transactions implementation. At the HIMSS09 Interoperability Showcase, the groups will demonstrate ways to implement the 5010 HIPAA transaction standards through testing tools, best practices and public-private collaborations already broadly recognized within the healthcare industry. These include CAQH’s Committee on Operating Rules for Information Exchange (CORE) Phase I and II rules certification testing scripts, the IHE interoperability framework, and Interoperability Specifications developed by the Healthcare Information Technology Standards Panel (HITSP). Successful completion of the project will demonstrate the synergies between 5010 guidelines and existing testing and certification efforts – initiatives that already have begun to support HIPAA 5010 transactions such as the use of patient financials.

 “HIMSS is excited to be collaborating with our industry colleagues on such an important topic, and pleased to host the demonstration as part of the HIMSS 2009 Interoperability Showcase,” said H. Stephen Lieber, HIMSS president and CEO.

Click here for more information.

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HIMSS10 Call for Proposals Now Open; Topic Categories Include Financial Information Systems

It’s not too early to start thinking about the 2010 Annual HIMSS Conference and Exhibition, Feb. 28 – March 4 in Atlanta. The HIMSS10 Call for Proposals is open now through Thursday, May 29. The proposal form and details on intended audiences, topic categories—including Financial Information Systems, and evaluation criteria are available online. The Call for Proposals closes at 5 pm Central Time on May 29.

Individuals with questions regarding submitting a Financial Information Systems proposal, including how to best frame your proposal, can contact Adam Bazer, manager of education, HIMSS, at abazer@himss.org or 312-915-9257.

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Ad in Wall Street Journal Highlights CORE Initiative

The March 11 issue of The Wall Street Journal featured a full-page ad highlighting the Committee on Operating Rules for Information Exchange (CORE) initiative. The ad is the centerpiece of a comprehensive outreach campaign to encourage CORE certification and endorsement by the industry, as well as convey the considerable progress the initiative has made in transforming electronic healthcare administrative data exchange.

CAQH, a nonprofit alliance of health plans and trade associations, is a catalyst for healthcare industry collaboration on initiatives that streamline healthcare administration, resulting in a better care experience for patients and caregivers.  CAQH solutions – like CORE - help promote quality interactions between plans, providers and other stakeholders, reduce costs and frustrations associated with healthcare administration and encourage administrative-clinical data integration. HIMSS is an endorser of CORE.

“The number of organizations represented “on the same page” in the ad speaks to the success of our approach and the real need for administrative simplification,” notes Gwendolyn Lohse, CORE Director, CAQH.

Click here for more information.

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Transforming Healthcare through Information Technology

By Dr. Rhonda Medows, Commissioner, Georgia Department of Community Health

Information technology has revolutionized our lives. It impacts the way we communicate, how we learn, work and spend free time. We use the Internet to make educated decisions about banking and shopping or we use text messaging to inform a friend if we are running late for coffee. Information technology is used in every aspect of our lives. And now we have opportunities to use it to improve healthcare outcomes and efficiency, and increase the overall quality of our healthcare delivery system.

To advance these opportunities, the Georgia Department of Community Health (DCH) has launched several health information technology initiatives and most recently has pulled together stimulus proposals for potential cyber-ready health information technology projects.

Georgia’s Transparency Web Site for Healthcare Consumers

DCH launched a healthcare consumer Web site in December. The Web site provides unbiased information on quality and cost of care and the availability of services across Georgia

With a single keystroke, consumers and caregivers are empowered to make informed choices about their healthcare. The Web site can be used as a planning tool to gather information about elective procedures, diagnostic tests, healthcare facilities with specialty services and prescription costs.  The site also incorporates MayoClinic.com disease management and wellness information for users.

Read the complete article.

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Medical Banking White Paper: Clearinghouse Perspective

By Dave Cheli

Earlier this year, the HIMSS Financial Banking and Healthcare Task Force released a white paper entitled, “Payments and Patient Finance: Where the Revenue Cycle Meets the Banking System” that discusses the interest and involvement that the banking industry has taken in the healthcare industry over the past few years. It identifies issues that currently exist in the revenue cycle management process and those that have arisen from previous efforts that were aimed at increasing automation but may have been shortsighted, such as the re-association of payments with electronic remittance advices (ERAs).

The paper provides a very detailed look at the payment system and the various financial transactions and processes that are currently in place to facilitate the movement of money. It includes a look at other services that banks offer, such as expanded lock box services, Intelligent Optical Character Recognition, and ePayment systems, and discusses how these can be used within healthcare to improve efficiencies within the revenue cycle management.

For healthcare clearinghouses, these new services provide a potential opportunity to offer more integrated solutions to providers. For example, by working with a provider’s bank, a clearinghouse could reconcile the deposit with the ERA that it currently delivers to the physician’s office. This would help streamline the deposit to the ERA reconciliation process.

A challenge, however, that any new entrant brings to an industry is trying to offer solutions without further confusing a user. As in all industries, a single, comprehensive solution that integrates complementary functions provides much value to a user and contributes to higher levels of efficiency.

It remains to be seen how tightly woven the banking and healthcare industries will become, but if the collaboration between all entities is focused on the common goals of increasing efficiencies and decreasing costs, success and new opportunities should be realized by both industries.

What are your thoughts on the role of clearinghouses?  Please submit your feedback to Nancy Vitucci, HIMSS Manager, Publications.

Dave Cheli is chief information officer for Gateway EDI, a national healthcare clearinghouse. He is the co-chair of the HIMSS Financial Edge eNewsletter Work Group and serves as the Advocacy Liaison of the HIMSS Midwest Gateway Chapter.

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Viewpoint: Compliance of the Recently Announced HHS Final ICD-10 Code Sets and Electronic Transaction Standards Rules

On January 15, the U.S. Department of Health and Human Services released two final rules that will facilitate the United States’ ongoing transition to an electronic healthcare environment through adoption of a new generation of diagnosis and procedure codes and updated standards for electronic healthcare and pharmacy transactions. On March 5, 2009, the Obama Administration released their decision to proceed with both final rules on ICD-10 and the Electronic Transaction Standards without changes to the effective dates. 

One rule replaces the ICD-9-CM code sets used to report healthcare diagnoses and procedures with the greatly expanded ICD-10 code sets, with a compliance date of Oct. 1, 2013. The second rule adopts an updated X12 standard, Version 5010, for certain electronic healthcare transactions, an updated version of the NCPDP standard, Version D.0, for electronic pharmacy-related transactions, and a standard for Medicaid pharmacy subrogation transactions; compliance dates include January 2012 for the Transaction Code Sets of Version 5010, Version D.0 and Version 3.0, with small health plans having until January 2013 for Version 3.0 compliance.

We posed the following questions to a few of our stakeholders: Are these timelines reasonable for achieving industry compliance of the two final rules? Will these timelines allow for adequate resource training and testing to ensure successful interoperability? What are the significant challenges anticipated with achieving these final rules?  

Here are a few perspectives on the subject:

The revised timeframes allow the industry to more effectively continue the momentum to achieve compliance as long as all players continue the work that has been done and don’t stall.  We have an excellent chance with the extra allotted time to complete adequate training and testing.

As a connectivity vendor and intermediary between providers and payers, testing for 5010 and then again for ICD-10 will be our most significant challenge. Because we are dependent on our partners’ schedules and readiness, a big agenda item is exploring economy of scale to conduct testing concurrently. 

Providers and payers also are both working to change business logic and getting them in sync logistically begets tactical and business process changes, for example, ensuring the new ICD-10 coding scheme doesn’t impart adverse financial conditions. Because of inherit complexities, I see a great need for end-to-end testing to truly know whether the claim has been successfully adjudicated.

-- Fred Richards, Vice President of Healthcare Strategy, RelayHealth

The three-year extension for converting from ICD-9-CM to ICD-10-CM should not provide organizations with a false sense of comfort. The impact of the change will be felt in almost all sectors of the healthcare industry. For example, decision-support vendors now map their content to ICD-9-CM. Changing to ICD-10-CM is a major undertaking and these companies require adequate time for testing and evaluation.

Payers' benefit plans are tied to ICD-9-CM and they are faced with transitioning to both ICD-10-CM and SNOMED CT. Hospitals' clinical, administrative, IT and other departments will be affected. In addition to converting their coding, many hospitals will also want the ability to continue accessing old data in a manner that allows an apples-to-apples comparison for their ongoing quality initiatives.

Although automated tools do exist that can greatly ease the transition, organizations should start planning now to ensure they have adequate time to select and implement the right technology solutions, training and process improvements.

-- George Schwend, President and CEO, Health Language, Inc.

When pharmacies, health plans, clearinghouses and their trading partners embarked on the first round of HIPAA earlier this decade, covered entities were moving from one electronic version of the NCPDP Telecommunication Standard to another. Analysis of post-implementation “lessons learned” has shown organizations generally should have spent more time on modifying business processes, developing and testing system and software changes, both internally and with their trading partners prior to the compliance date.

NCPDP has developed a White Paper as guidance to the pharmacy industry in preparing for the implementation of the newly-named versions, and to a new NCPDP Medicaid Subrogation HIPAA standard. In developing a more granular pharmacy industry timeline within the confines of the final rule, NCPDP hopes to aid industry in providing early action and sufficient time for the industry to implement compliant processes. HHS stated in the final rule that there will be no contingency period.

Click here for additional information on the 2009 HIPAA Transactions and Code Sets Regulations and work efforts of NCPDP’s SNIP Liaison Special Committee.

-- Catherine Graeff, RPh, MBA, is Sr. Vice President, Communications and Industry Relations, NCPDP

We would like to hear from you. Please submit your view on ICD-10 to Nancy Vitucci, HIMSS Manager, Publications.

The inclusion of an organization name, product or service in Viewpoint should not be construed as a HIMSS endorsement of such organization, product or service, nor is the failure to include an organization name, product or service to be construed as disapproval. The views expressed in Viewpoint are those of the author and do not necessarily reflect the views of HIMSS.

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ICD-10 Annual Summit—The Source for Information, Education and Resources for ICD-10-CM and ICD-10-PCS Preparedness and Implementation

April 16-17, Washington, DC

At the ICD-10 Annual Summit, healthcare leaders will examine strategies for successfully implementing ICD-10-CM and ICD-10-PCS and the impact implementation could have on reforming the nation’s healthcare system. The ICD-10 Annual Summit is sponsored by AHIMA, the American Hospital Association, and the American Association of Health Administration Management, in collaboration with HIMSS. Education offerings during day one will focus on leveraging ICD-10-CM and ICD-10-PCS implementation and compliance into a strategic advantage. During day two, participants will explore critical issues; practical ICD-10-CM and ICD-10-PCS implementation tactics will be examined. Early bird registration will close on Friday, April 10; source code MX2644 should be referenced when registering.

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