HIPAA 5010 Standards Are Now in Effect

The HIPAA 5010 standards went into effect January 1st, 2012, and as a result may impact claims payments and other HIPAA-covered electronic transactions if either you or your trading partners have not yet made the required changes.

The new 5010 standards apply to all electronically-submitted HIPAA-covered administrative transactions, such as checking a patient’s eligibility, filing a claim or receiving a remittance advice. The new standards mostly affect the configuration of software used in conducting such transactions, but they may also impact physicians who may be required to upgrade billing or EHR systems and/or to make changes in the type of information they collect from patients. Although CMS recently announced a "discretionary enforcement period" through March 31st, this unfortunately means little for physicians since many entities were in compliance by January 1st, and have begun rejecting noncompliant claims. Some payors may choose to continue paying noncompliant claims during this enforcement period.

Regardless, physician practices should immediately contact the trading partners you work with who are primarily impacted by the change (i.e. billing services, EHR vendors, clearinghouses, etc.) to determine how these changes impact your practice specifically. The following tips may help you get the information you need from your trading partners:

Talk to your current practice management system or EHR vendor.
Talk to your clearinghouses or billing service (if you use either one) and health insurance payors.
Identify specific changes they have made to their systems that impact the data you must collect and report to meet these new standards
Identify the processes and people affected by these changes
Modify work flow and business processes to account for changes
Train staff in new changes before January 1st
Test with your trading partners, e.g., payors and clearinghouses

Affiliated Computer Services (ACS) - New Medi-Cal Fiscal Intermediary

Affiliated Computer Services (ACS) will take over as the new Medi-Cal fiscal intermediary on Monday, October 3. At that time, ACS will assume full responsibility for Medi-Cal claims processing and related services.
The Department of Health Care Services (DHCS) expects that there will be minimal or no impact on the provider community. Physicians should, however, be aware that Medi-Cal will be closed for one day, this Friday, September 30, to prepare for the hand off to ACS. Automated phone lines will also be down from 11:59 p.m. Friday until 8 a.m. Saturday morning. Electronic claim submission will also be available during this brief window.
DHCS does not anticipate any payment delays as a result of the transition. CMA members who experience problems should contact CMA reimbursement advocate Frank Navarro at (916) 551-2046.
For more information, see files.medi-cal.ca.gov/pubsdoco/newsroom/newsroom_20026.asp.

5010 Compliance Deadline

As of January 1, 2012, Version 5010 will be required for all HIPAA standard transactions. This means:

 · Beginning Jan 1, 2012 HIPAA Version 4010A1 will no longer be accepted by Medicare.

· All trading partners must operate in HIPAA Version 5010.

 It is essential to begin the transition now to prevent a disruption to your claims processing and cash flow.

 If you have not done so already, CMS strongly encourages you to begin exchanging Version 5010 transactions with your Medicare Administrative Contractor (MAC) NOW to ensure compliance with the January 1, 2012 impact date.

 As a reminder, CMS offers free billing software that is Version 5010 compliant. Please contact your MAC, FI or Carrier to obtain the latest Version of PC-Ace Pro32. CMS also provides the Medicare Remit Easy Print (MREP) software to view and print compliant HIPAA 5010 - 835 remittance advices. Please visit www.cms.gov/AccesstoDataApplication/02_MedicareRemitEasyPrint.asp to view this software.

 Medicare FFS providers should take advantage of the many resources CMS has provided on the 5010 dedicated website located at www.cms.gov/Versions5010andD0/

Don’t wait! TEST NOW to avoid possible delays in payment due to the end-of-year rush in 5010 testing. Testing now will allow time for any needed corrections prior to Jan 1, 2012 – the date when only 5010 transactions will be accepted.

Alert! Medicare eRx Payment Adjustment - November 1, 2011 Deadline Approaching

In 2012, the payment adjustment for not being a successful electronic prescriber will result in an eligible professional or group practice receiving 99% of their Medicare Part B PFS amount that would otherwise apply to such services. Eligible professionals and group practices should determine if they are subject to the 2012 eRx payment adjustment by reviewing the Medicare Learning Network Article # SE1107 available at www.cms.gov/MLNMattersArticles/downloads/SE1107.pdf. If you believe that you may be subject to the 2012 eRx payment adjustment, you should determine if you meet any of the hardship exemption categories specified by CMS in the 2011 Medicare Electronic Prescribing (eRx) Incentive Program Final Rule. A Quick Reference Guide is available at www.cms.gov/ERxIncentive/Downloads/2011eRxRule-QRG_09-06-2011F.pdf to help you understand the changes that the eRx Final Rule made to the 2011 Medicare eRx Incentive Program. As a result of changes to the program, eligible professionals and group practices have until November 1, 2011 to submit a significant hardship exemption request and rationale. Individual eligible professionals must submit their hardship exemption requests through the Quality Communications Support Page (www.qualitynet.org/portal/server.pt/community/communications_support_system/234) and group practices participating under the group practice reporting option (GPRO) must submit hardship exemption requests via a letter to CMS. Additional information and resources are available at www.cms.gov/erxincentive.

NVMA, CalHIPSO & HSAG Site Visit Update

Kathy Fraser, Office Manager for Everett Trevor, MD(left)

Kathy Granata, Office Manager for Thomas Russ, MD(center)

Evie Barday, Front Office Supervisor for SCHC(right)

NVMA, CalHIPSO & HSAG Site Visit Update
July 1, 2011

North Valley Medical Association’s Outreach Partner Project with CalHIPSO ended June 30, 2011. The NVMA was very excited to participate in this project and conducted several monthly outreach meetings to physicians in a six county region. Participation in these meetings was excellent, both physicians and staff representing 100 practices attended to learn more about transitioning to Electronic Health Records and the resources available through CalHIPSO.

As a finale to this project, the NVMA conducted a site visit at Shasta Community Health Center (SCHC) for a “hands on” demonstration of EHR. The response to the site visit was fantastic and, due to limited group size, a second visit has been scheduled for later this month. We are extremely grateful to SCHC for opening their clinic to our tour and dedicating the staff time to provide a very educational experience for our physician community.

SCHC Chief Information Officer, Charles Kitzman, suggested the following for physicians looking to adopt EHR:
• Now is a good time to adopt EHR as the processes are in place with vendors to ensure a successful transition.
• System cost is always a consideration, incentive payments and discounts through CalHIPSO can mitigate the overall expense.
• Consider the use of scribes to assist physicians in the transition to EHR.
• Training and testing is critical when adopting a system.
• Transfer of paper records to electronic records requires a systematic approach – get the consensus of the team.
• Work flow will change – do not adopt bad work flow processes.
• EHR will integrate your practice, it is important to conduct quality audits to ensure that correct entry occurs.

Although the CalHIPSO project has ended, the NVMA is acutely aware that many of our physicians are still requesting assistance with the process. We are considering user group meetings and vendor presentations over the next several months as part of our commitment to the physician community and will be communicating with our members as more information becomes available.

Physicians, who have not participated with the CalHIPSO project and are interested in learning more, may click the CalHIPSO link on our website or contact Deb Schoenthaler at 247-0293.

Karen Preisser
Deb Schoenthaler
Outreach Co-Partners

DHCS Announces Plans to Recoup Medi-cal Payments

The Department of Health Care Services (DHCS) recently announced it intends recoup a 10 percent reduction in Medi-Cal provider payments retroactive to June 1, 2011, cuts that were originally approved as part of the California Budget Act of 2011 but were only recently approved by the Federal government. Now that the State has approval for the cuts, DHCS intends to retroactively recoup these payments back to July 1st.

DHCS has indicated that recoupments will happen over an extended period, likely more than a year. Providers will be notified in writing of the amount that will be recouped from them. CMA has asked that physicians receive detailed accounting of the recoupment (patient names, dates of service, etc.) so that physicians can reconcile their books. DHCS will employ their standard processes for a payment correction, and the recoupment could be done as a 5 percent additional reduction in future payments, on top of the 10 percent reduction. Physicians will have some ability to work out repayment plans through the Medi-Cal fiscal intermediary.

Seeking recoupment of provider payments is a direct result of the California Budget Act of 2011.On October 27, the Centers for Medicare & Medicaid Services (CMS) approved key elements of the state’s 2011-12 budget proposals to reduce Medi-Cal provider reimbursement rates, effective retroactive to June 1, 2011.