Some software vendors have not yet issued HIPAA 5010 enhancements, let alone those for ICD-10. What's more, providers and payers should already be gearing up for internal testing of HIPAA 5010 and at least beginning the ICD-10 implementation phase. So without the upgrades, what are providers and payers to do?
“We are very disappointed with the apparent delays from our software vendors. Some are indicating ICD-10 upgrades at very late dates. All are indicating late dates for 5010 upgrades,” says a project manager at a major provider who requested anonymity.
In all fairness to vendors, they are neither the only ones running late nor should they shoulder all the blame. “Since technology changes are secondary to procedural changes, I would argue if we are gauging the industry we could just as easily argue providers won't be ready on time,” says Tori Sullivan, a manager in Capgemini's healthcare division who also chairs HIMSS ICD-10 Task Force.
Glued to each other
As is so often the case for software, ICD-10 vendors and their customers have a co-dependent style of relationship. Sharon Perkins, director of IT and HIPAA security officer at El Paso Health Plan explains how that works. “We need a partner in our software vendor to take us to the next level of where we need to be for compliance because not only are we looking at 5010 and ICD-10 but there’s a national healthcare initiative that’s rolling out at this time, too, and that has an impact. So we look for partners with our software vendors to be in tune with the ongoings of the industry.”
The National Committee on Vital and Health Statistics (NCVHS), an advisory committee to HHS, determined through interviews that many experts are questioning whether practice management or healthcare vendors will even be ready to support the HIPAA standards.
[Related: 8 steps for starting HIPAA 5010 migration. See also: Deloitte's top 10 ICD-10 list.]
Based on the schedules recommended by CMS, WEDI, and others, companies should now be preparing for Level 1 Compliance for HIPAA 5010 by January 1, 2011, so that they can spend next year testing. That would make 2011 “a transition period,” explains George Vancore, an IT systems integrator within Blue Cross and Blue Shield Florida's regulatory mandates and compliance program office. “You need to transition from 4010 to 5010.”
Such transitions, for both 5010 and ICD-10, will be arduous and complex indeed. 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.
In the meantime
Whether vendors deliver the updates on time or not, the ultimate responsibility resides with providers and payers. “We are at the mercy of the vendors for timing, and these are not small vendors,” said the anonymous project manager. “We're the ones who get the penalty for a non-compliant claim”
There are options, though unfortunately most are in the realms of longshot or desperate. Providers or payers facing a vendor who is not going to make the deadline can take the dramatic approach of switching to another vendor who will meet the deadline, start a letter-writing campaign aiming to convince CMS to delay the compliance date yet again, become active in the vendor user groups, or essentially isolate the system until the vendor releases a patch.
“The thought of switching to another vendor, unless you have some other business reason, probably would not be a viable option. I’m not certain it would make sense unless you have some idea that the vendor is going to go out of business,” says Pam Ruebelmann, vice president of healthcare at HighPoint Solutions. “But if it’s just a matter that those releases are going to be late, then the only thing you can do to stay compliant is have some other mechanism of doing translation, to isolate that system so it’s not impacted and you can continue operating.”
Those suggestions are dramatic, if not bleak. So is taking legal action against the vendor. “Before jumping the gun and pursuing legal recourse, I suggest finishing the assessment phase,” Capgemini's Sullivan says. “Then determine vendor time lines and start testing with the earliest vendor first. No organization can test all applications with all the new modifications at the same time. They will need to complete individual system system testing prior to integrated testing.”
And there are things providers can do while they wait. The anonymous project manager suggests that healthcare organizations identify all the players and get their status as soon as possible, including all applications that provide billing processes or touch 5010 or ICD-10 in some way.
[Related: Top 5 ICD-10 myths, debunked. See also: Why 2010 is the pivotal year for ICD-10.]
“We have started engaging our clearinghouses and getting their dates. We have also identified what payers we want to test with, and will be engaging them over the next several weeks. We are taking the position that any ASPs doing billing for us have to provide schedules on when changes are being made and evidence of successful testing,” the project manager continues. “We are pushing back on the vendors trying to say 'don't worry, we've got you covered.' I don't want to know the specifics of what they're doing but I have to know when they're doing it and the sign-off that it was successful.”
Not just software
The good news is that there's more to HIPAA 5010 and ICD-10 than just software; the bad news is that it takes a whole lot more than just vendor-supplied software updates to comply with either.
The IT side of the conversions comprise somewhere around 25 percent of the transition, while the remainder of the impact will be felt on the business end of things, Stanley Nachimson, co-chair of WEDI's timeline initiative told ICD10Watch.
“While the task of converting vendor's systems is considerable, it pales by comparison to the changes needed in the business and clinical processes that use the systems,” explains Frank Reilly, senior consultant at the Hazen Group, a healthcare consultancy. “This transitions goes far beyond systems vendors making changes to software. Every provider and payer, to one degree or another, needs to think about how their business is going to change – and prepare.”
Tom Sullivan blogs regularly at ICD10 Watch.com.
