Is Your Practice Ready for HIPAA Transactions, Code Sets and Testing?

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Is Your Practice Ready for HIPAA Transactions,
Code Sets and Testing?
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Are You Ready for HIPAA Transactions?

• Realize current proprietary formats are going
  away
• Switch to the HIPAA compliant electronic
  transaction formats (e.g., 837 v.4010 format) and
  national code sets
• Begin integrity testingTest your internal
  systems first with a qualified third party before
  B2B transaction testing with MDCH
• Start B2B transaction testingGet your 837 v.
  4010 claims in for testing with MDCH now
• Begin testing your other HIPAA Transactions in
  April 16, 2003
• Be HIPAA compliant by October 16, 2003

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HIPAA Mandated Standards
Administrative Simplification
Electronic Data Transmission
Data Protection
Transactions
Code Sets
Identifiers
Security
Privacy
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What are the Benefits of HIPAA?

• HIPAA was designed to provide many benefits to
  both medical offices and patients.
• Some immediate benefits include
• Reduces administrative burden and cost for
  providers and payers
• Creates a national standard for electronic
  transactions
• Increases speed of financial transactions
  resulting in faster payment for services
• Simplifies the exchange of information and
  reduces paperwork
• Provides a more complete picture of healthcare
  and improves quality
• Improves privacy and security of healthcare
  information

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HIPAAs Impact on Health Care Providers

• Post HIPAA, health care providers are more likely
  to
• Replace paper (encounter and billing sheets,
  medical records)with computerized processes
• Be paid electronically and more rapidly
• Use the Internet for healthcare business and
  information
• Use only national codes
• Use common identifiers (except for patients), and
  expect these identifiersto be accepted
• Be more security-conscious and expect this of
  others

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Electronic Transaction Benefits

• Electronic transactions provide significant
  benefits compared with paper transactions
• EDI streamlines transaction processing. Formats
  are pre-edited to reduce common errors in claims
  data entry. This reduces the re-entry of the same
  data. It also reduces delays caused by scanning
  and re-keying. EDI also reduces operating costs
  and increases staff productivity.
• Improves cash forecasting cash flow. Faster
  submission of accurate claims results in quicker
  payments and reduced receivables.
• Provides positive acknowledgement of transaction
  receipt
• Eliminates the cost of handling and storing
  paper documents

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The Electronic Transactions
837 Institutional Claims and Encounters 837 Profes
sional Claims and Encounters 837 Dental Claims
and Encounters 835 Claim Payment and Remittance
Advice 834 Enrollment and Disenrollment 820 Capita
tion Payment Transaction
276 Claim Status Request 277 Claim Status
Response 270 Eligibility Request 271 Eligibility
Response 278 Referral Authorization
(Request) 278 Referral Authorization (Response)
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Preparing for HIPAA Michigans Uniform Billing
Project

• Michigans Governor mandated Uniform Billing for
  the states Medicaid Program.
• The new system simplified the old billing
  process adopted standard healthcare industry
• claim formats and code sets and was the first
  step toward HIPAA compliance.
• The project was initiated in early 2000.
• Replacing all proprietary claim formats with
  industry standard formats
• Working with affected associations and provider
  groups to communicate the changes
• Preparing and training thousands of billers and
  reimbursement specialists for conversion
• Testing claims

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Michigan MedicaidInformation System (MMIS)

• The Michigan Department of Community Health
  (MDCH) is the single state agency for Medicaid
• MDCH operates its own management information
  system and makes continual updates to its MMIS
• Converting the MMIS to HIPAA compliance has been
  a large multi-year project
• MDCH works with outside consultants to ensure
  MMIS is HIPAA compliant
• MDCH works with outside consultants to educate
  providers through outreach efforts

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Provider Education and Outreach

• MDCH is working with your association to ensure
  successful HIPAA conversion through
• Education and outreach meetings and seminars with
  Providers like you
• MDCH web site www.michigan.gov/mdch
• HIPAA Primer at www.healthcare.mivu.org
• www.mihealth.org your link to Michigan Health
  Resources and complete details about HIPAA
  Transactions including updated questions
  answers
• HIPAA Transactions Brochures
• HIPAA Transactions Newsletters
• Frequently Asked Questions updated constantly
  on the MDCH (www.michigan.gov/mdch) and
  mihealth.org web sites

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MDCH HIPAA Transaction Compliance Plan

• Stay in compliance with the HIPAA law and in sync
  with BCBSM and other large payers (Medicare A
  and Medicare B) implementation plans
• Strongly encourage providers to send electronic
  transactions to take advantage of HIPAAs
  benefits
• Implement electronic transactions incrementally
• October 1, 2003 Began Accepting 837 v. 4010
  Dental, Professional and Institutional Claims
• January 1, 2003 Began Accepting 837 v. 4010
  Encounters from Medicaid Health Plans
• Began Accepting 837 v. 4010 Nursing Facility
  Claims
• April 16, 2003 Begin Testing Other HIPAA
  Transactions
• October 16, 2003 Only HIPAA compliant Claims
  and Transactions accepted

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Switch to the HIPAA Compliant Professional
Services Claim Format

• Covered Entities Current Claim Format HIPAA
  Compliant Format
• All Professional Services 837 v.3051 will be
  accepted 837 Professional v.4010
• Providers (listed below) until 10-16-03 is
  currently accepted

• Physicians
• Advanced Practice Nurses
• Podiatrists
• Chiropractors
• Independent Clinical Labs
• Independent Private Duty Nurses
• Medical Clinics
• Family Planning Clinics
• Childrens Waiver Service Providers
• Ambulance
• School-based Services

• Maternal/Infant Support Services Providers
• Hearing Speech Centers
• Optometrists
• Medical Supply/DME Providers
• Orthotists/Prosthetists
• Optical Companies
• Oral Surgeons
• FQHCs/RHCs/IHCs
• Physical Therapists
• CMHSPs and Substance Abuse CAs

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The Mandated Code Sets

• CPT and HCPCS Level II--all services billed on
  professional format
• CDT-Dental Services
• NDC-Drugs
• ICD-9-CM Vol. 3, Codes Inpatient Hospital
  procedures
• ICD-9-CM Vol. 1 2 Diagnosis codes for all
  providers
• National codes will be updated on an annual basis

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What Providers Must Know about Code Sets

• MDCH has replaced most local codes.
• Providers will have notice of any outstanding
  local procedure code conversion to national codes
  by August 1, 2003. If a code requires a policy
  change public comment will begin April 1.
• All Medicaid code sets must be utilized by date
  of service. If the date of service is prior to
  October 16--and a local code was in effect-- that
  local code must be used regardless of when the
  claim is submitted.
• Service rendered on or after October 16 will
  require standard HIPAA compliant codes.
• Submit your test claims with current codes until
  MDCH notifies you of changes
• Pay attention to your national code set group and
  MDCH for additional guidance.

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Re Code Sets Paper and Electronic Billers Need

• To PURCHASE your correct national code set
  manual
• MDCH Medicaid Billing manual with Chapter IV for
  your provider type
• MDCH numbered letters and bulletins for your
  provider type

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Testing Electronic Transactions

• Stage 1 System Integrity Testing
• MDCH recommends providers successfully complete
  third party testing from an independent service
  (like Foresights HIPAA Validator) prior to
  transaction (B2B) testing to confirm HIPAA
  compliance. Be advised that successful Integrity
  testing does not mean that your files meet all
  MDCH rules for Transaction (B2B) testing.
• Stage 2 Transaction (B2B) Testing
• Transaction testing determines if trading
  partners can successfully transmit and receive
  HIPAA compliant transactions. Providers should
  submit a small but relevant sample of
  transactions to payers (i.e., MDCH, BCBSM) to
  assure business to business file compatibility.
• Note
• Instructions for the Foresight HIPAA Validator
  and for submitting test claims to MDCH can be
  found at www.michigan.gov/mdch and
  www.mihealth.org.

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Resources Needed Prior to Testing Electronic
Transactions

• National Implementation Guides and Clarification
  Documents www.wpc-edi.com/hipaa/hipaa_40.asp
• Michigan Medicaid Clarification
  Documentswww.michigan.gov/mdch (click on
  Providers, Information for Medicaid Providers)
• MDCH Electronic Submission Manual
  www.michigan.gov/mdch (click on Providers,
  Information for Medicaid Providers)
• Code Set Manuals for your Professional Provider
  Type
• CPTwww.ama-assn.org
• HCPCS cms.hhs.gov/medicare/hcpcs/default.asp
• ICD-9www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/ftp
  icd9.htm

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Provider Checklist for 2003

• Submit Electronic Transactions and Take Advantage
  of HIPAAs Benefits
• Partner with a HIPAA Compliant Electronic Biller,
  Practice Management Vendor or Clearinghouse, or
• Purchase a HIPAA Compliant Software Billing
  Package
• Switch to the New Standard Formats and Code Sets
• Begin Testing Internal Systems First for
  Integrity and Syntax to Achieve HIPAA Compliance
• Begin Testing B2B Transactions with Payers to
  Assure Compatibility with Your System
• Start Testing 837 v. 4010 Claims Now

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Provider Checklist for 2003

• Begin Testing All Other Transactions April 16,
  2003
• Pay Special Attention to Your National Code Set
  Group and MDCH for Guidance
• Submit Test Claims with Current Codes until
  Notified Otherwise
• Purchase Your Correct Code Set Manual
• Download Your MDCH Provider Type Medicaid Billing
  Manual Chapter IV
• Review MDCHs Numbered Letters and Bulletins for
  Your Provider Type
• Check with Other payers for Details about their
  HIPAA Implementation Plans, Key Dates, and
  Testing Schedules
• Be HIPAA Compliant by October 16, 2003

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For More Information

• Contact the Michigan Department of Community
  Health
• MDCH www.michigan.gov/mdchofficial policy and
  information for HIPAA Transactions
• MDCH Provider Hotline [phone]
• MDCH providersupport_at_michigan.gov
• www.mihealth.org your link to Michigan Health
  Resources and complete details about HIPAA
  Transactions including updated questions
  answers
• HIPAA Primer www.healthcare.mivu.org

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Slide Presentation Last Updated January 28, 2003