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Will There be a Train Wreck on October 16, 2003?

HIPAA Audioconference August 14, 2003 Kepa Zubeldia, M.D., Claredi. Will There be a Train Wreck on October 16, 2003?. Topics. Facts The CMS meeting yesterday Realistic alternatives Contingency vs. Long Term Will there be a train wreck? Recommendations. Facts.

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Will There be a Train Wreck on October 16, 2003?

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  1. HIPAA Audioconference August 14, 2003 Kepa Zubeldia, M.D., Claredi Will There be a Train Wreck on October 16, 2003?

  2. Topics • Facts • The CMS meeting yesterday • Realistic alternatives • Contingency vs. Long Term • Will there be a train wreck? • Recommendations

  3. Facts • Most entities want HIPAA to work • Most entities are not 100% ready for all HIPAA transactions • Both payers and providers will do whatever it takes to not disrupt the payment process

  4. CMS meeting yesterday • CMS will not evaluate whether your particular contingency plan is good or not • CMS will look at whether you have a contingency plan • CMS expects good faith efforts • Publish your contingency plan ASAP • No “undisclosed” contingency plans

  5. Realistic Alternatives • Continue with the current legacy transactions, WITHOUT CHANGE, until you can transition to HIPAA • Relax/improve the HIPAA transactions • Reduce the “edits” that are causing most rejections at payer end • Capture the data that are causing most rejections at provider’s end • Use “dummy” data to “gap fill” • Use a clearinghouse

  6. Contingency vs. Long Term • Contingency plans will be discontinued at certain point in time • Need long term solution to issues: • Rejecting a batch because one claim is bad • Rejecting an imperfect transaction • When long term issues are resolved the need for contingency plans is reduced.

  7. Will there be a train wreck? • No • Nobody wants a train wreck • Contingency plans will take care of the immediate problem • HIPAA implementation is going to take more than a few weeks  • Construction zone • Moving toward compliance • Raising the bar gradually

  8. Recommendation #1 • Assess your HIPAA compliance as of today • Providers: Percentage of your transactions that is accepted by your trading partners as HIPAA transactions • Payers: Percentage of your transactions that you accept as HIPAA • Expect these percentages to be very low today, probably close to zero • Establish baseline

  9. Recommendation #2 • Re-evaluate your compliance ratios for each transaction monthly • Keep increasing the ratio • Do not expect perfection, targeting 100% as the long term goal may be unreasonable • Document your efforts as good faith testing and due diligence • Use third party (e.g. Claredi) to document your efforts

  10. Other Recommendations • Publish your contingency plan • Minimal change/disruption plan • Don’t give up on HIPAA • Relax, there is no train wreck, only a construction zone • Keep improving your HIPAA systems and document your progress

  11. Questions ? Kepa Zubeldia, M.D. President & CEO Claredi Kepa.Zubeldia@claredi.com (801) 444-0339

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