Top 5 HIPAA 5010, ICD-10 hurdles

It's no secret that the government mandated dynamic duo - that being HIPAA 5010 and ICD-10 - requires changes enormous in both number and scope. What's not as well understood is all the challenges they present.

HIPAA 5010 carries at least 1331 modifications spanning all 9 standard electronic transactions, while ICD-10 adds five times as many codes.

The most significant hurdle healthcare organizations face on the path toward both HIPAA 5010 and ICD-10, however, can be whittled down to the “T-word,” as in “testing.” All three panelists agreed on that, during the Preparing for the Future: 5010 Implementation webinar in late March; they included representatives from Blue Cross and Blue Shield of Florida, Tampa General Hospital, and PNC Healthcare. Thus, a provider, payer, and clearinghouse.

[Related: Top 5 ICD-10 myths, debunked. See also: 7 Questions to ask yourself about the HIPAA 5010 conversion.]

Testing might be the single most important challenge that HIPAA 5010 and ICD-10 pose, but it's neither the only nor the first. Here's a list of the top five.

1. Education

Increasing awareness of technological and process changes that the new mandates will create is not only a huge undertaking but perhaps the foundation of project success. In the case of Blue Cross and Blue Shield of Florida, that means making sure that some 1,300 trading partners are included, according to George Vancore, an IT systems integrator within BCBS Florida's regulatory mandates and compliance program office.

“We need to do a great deal of education to make sure everyone understands the changes, both internally and externally,” adds Pamela Grosze, vice president, manager healthcare operations payer services, PNC Healthcare.

2. Engagement of vendors and partners

Providers are ultimately responsible for compliancy, says Gale Scott, the HIPAA transaction compliance administrator at Tampa General. But providers cannot succeed alone. Scott recommends getting firm delivery dates from vendors as a start.

“Don't accept the mantra from trading partners that 'we'll be compliant on January 1, 2012,'” Vancore adds. “That's not my problem. I need to know when you can test with me.”

3. Testing

“Testing is going to be the issue,” Grosze says. “It all gets back to testing,” because PNC, and others, need to identify customizations, such as provider- or payer-specific modules that need to be changed, and ultimately “evaluate all our transactions, end-to-end.”