San Francisco Medical Society Blog

Outdated Communication Technologies Cost U.S. Hospitals More than $8.3 Billion Annually

Thu, 09 May 2013 13:44:41 GMT

U.S. hospitals lose a total of $8.3 billion annually due to inefficient communications technology, according to a new report from the Ponemon Institute the Wall Street Journal's "CIO Journal" reports.

The report was sponsored by Imprivata, a provider of health care security software and services.

For the report, Ponemon surveyed 577 health care and health IT professionals at medical facilities that ranged in size from having fewer than 100 beds to having more than 500 beds.

Findings on Communications Tools

The survey asked participants about the challenges they encounter in using communications tools, finding that:

52% of respondents said that pagers are inefficient
39% said that Wi-Fi is not available
38% said that their email system is inefficient
36% said that text messaging is not allowed
28% said that personal mobile devices are not allowed

Findings on HIPAA's Effects

The survey also asked participants about the effects of complying with HIPAA, finding that:

85% of respondents said that HIPAA reduces the amount of time available for delivering care
79% said that HIPAA makes accessing electronic patient data difficult
59% said that the complexity of HIPAA requirements were a major barrier to modernizing the health care system
56% said that HIPAA restricts the use of electronic communications

Findings on Time Spent Communicating

Survey participants also answered questions related to time spent communicating. The survey found that:

Clinicians said they waste an average of 46 minutes daily as a result of using outdated communications technology
Clinicians estimated that only 45% of each workday is spent with patients, with the remaining 55% being spent communicating and collaborating with other clinicians, as well as using electronic health record systems and other IT tools
65% of respondents said that they believe that secure text messaging could cut patients' discharge time by 50 minutes

Findings on Costs

The report estimated that inefficient communications technology causes the U.S. hospital industry to lose:

More than $5.1 billion annually as a result of decreased physician productivity and the decreased time that physicians have available to spend with patients
About $3.2 billion annually as a result of lengthy patient discharge times

Source: California Healthline, May 9, 2013.

HHS Unveils Final Rules Expanding, Updating HIPAA Provisions

Fri, 18 Jan 2013 10:44:52 GMT

HHS released four final rules expanding and updating the Health Insurance Portability and Accountability Act (HIPAA).

The rules implement tougher privacy and security provisions.

Clarify when breaches must be reported to HHS' Office for Civil Rights;
Establish new standards for the use of patient-identifiable information for fundraising and marketing;
Expand liability to "business associates" of hospitals and other "HIPAA-covered entities," such as data miners and health information technology service providers; and,
Raise the maximum penalty for noncompliance to $1.5 million per violation.

According to HHS, the rules stemmed in part from an executive order that directed HHS to conduct a retrospective review of existing regulations to determine ways to reduce costs and increase flexibility under HIPAA.

Click here to view the final rules.

Source: California Healthline, January 18, 2013.

HHS Delays ICD-10 Coding to October 2014

Mon, 27 Aug 2012 12:57:26 GMT

The Department of Health and Human Services (HHS) postponed the use of ICD-10 diagnostic codes until October 1, 2014.

The 1-year delay comes in response to complaints by organized medicine about the administrative burden of converting to ICD-10. SFMS, CMA, AMA, and other medical societies told HHS that converting to the more voluminous and complicated set of diagnostic codes could cost medical practices tens of thousands of dollars and interfere with their migration to electronic health records and electronic prescribing.

ICD-10 stands for the International Statistical Classification of Diseases and Related Health Problems, 10th Revision. The Centers for Medicare and Medicaid Services (CMS) mandated the switch from ICD-9 to ICD-10 as part of implementing the Health Insurance Portability and Accountability Act (HIPAA). HHS considers ICD-9 outdated and imprecise.

ICD-10 contains 68,000 diagnosis codes, which is roughly 5 times the number in ICD-9. The new codes also run to a maximum of 7 characters compared with 5 in the current codes.

HHS also announced establishing a standard format for health plan identifier (HPID) codes that is designed to simplify billing for clinicians and hospitals. Identifiers for health plans now in use differ in format, and that variety invites errors, leading to misrouted transactions, rejected claims, and problems determining patient eligibility, according to HHS. The department estimates that implementing a standard HPID will save the healthcare industry up to $6 billion over the course of 10 years.

Click here for more information on the HHS announcement.

Electronic Remittance Advice Enhancements

Tue, 31 Jul 2012 14:56:26 GMT

Under the new Health Insurance Portability and Accountability Act (HIPAA) version 5010 standards, the electronic remittance advice (ERA) transaction has been enhanced to include such information as a patient’s coverage expiration date and the claim received date. In addition, ERAs for Medicare claims will include national and local coverage determinations so physicians can easily identify which items and services Medicare will cover. These changes will eliminate much of the time-consuming research physicians previously had to perform.

Click here to learn more about the benefits of using ERA from an AMA webinar.

Accepting electronic remittance advice (ERA) and automating your claims process can:

Speed up payment
Save time spent on manual processes such as opening mail, filing and phone calls to health insurers
Eliminate lost EOBs and expedite filing to secondary payers
Free time for revenue-enhancing functions such as ensuring correct payment

Cost of paper EOBs: $2.96 x 6200 = $18,600
Cost of electronic remittance advice: $1.48 x 6200 = $9,176

Annual savings from claims automation per physician: $9,424*
*Based on an annual average of 6,200 claims submitted for a single physician. Source: Milliman, Inc., Electronic Transaction Savings Opportunities for Physician Practices. Technology and Operations Solutions. Revised: January 2006

5010 Format Required for Electronic Claims Beginning July 1

Tue, 12 Jun 2012 14:52:20 GMT

The deadline for transitioning electronic transactions to the updated 5010 version of the Health Insurance Portability and Accountability Act (HIPAA) transactions standards is July 1, 2012. The Centers for Medicare & Medicaid Services (CMS) had previously moved back the enforcement date to allow the industry more time to convert to the new format. CMS now believes that a sufficient number of practices have effectively made the transition and physicians will begin seeing rejected claims as of July 1, if they are not submitted in the new format. You will be required to conduct electronic transactions such as claims submissions, eligibility verification, claims status, remittance advice and referral authorizations using the updated transaction standards.

If you have not successfully converted your programs to 5010, consider using the free CMS software programs PC-Ace Pro 32 (for Medicare claim submission) and EasyPrint (for Medicare electronic remittances). Both programs are available for download from the Palmetto GBA website, www.palmettogba.com/j1b. Click on EDI in the left menu, then on "Software and Manuals."

Commercial payors will also require practices to submit electronic claims in 5010 format on July 1.

SFMS/CMA surveyed the major payors in California to determine their claim submission requirements. While some did require 5010 on January 1, others allowed for contingencies.

Click here to access our member-only reference guide to help with transitioning to 5010 as well as a list of requirements by payor.

Ready for Version 5010?

Wed, 30 May 2012 12:22:24 GMT

Centers for Medicare & Medicaid Services (CMS) Regional Offices are hosting a series of webinar on Version 5010 for health care providers, clearinghouses, vendors and others.

Version 5010 refers to the standards that HIPAA-covered entities must use when electronically conducting certain health care administrative transactions, such as claims, remittance, eligibility, and claims status requests and responses.

Health care organizations that submit transactions electronically are required to upgrade from Version 4010/4010A to Version 5010 transaction standards. To be compliant, organizations must use Version 5010 to send and receive claims and all other HIPAA-adopted electronic transactions starting January 1, 2012; however, CMS has implemented an enforcement discretionary period, which is in effect through June 30, 2012.

Current Conversion Statistics
Final Preparations for 5010/D.0 Cutover
Operational Concerns
Future of EDI Communications
Resources and Contact Information

The next webinar is scheduled for Wednesday, June 20, 2012, from 1:00 pm to 2:00 pm PST.

Click here to register.

Medicare Announces Another Extension of HIPAA 5010 Enforcement

Fri, 16 Mar 2012 09:41:15 GMT

The Centers for Medicare & Medicaid Services (CMS) announced yesterday that they would again extend the enforcement discretionary period, allowing practices an additional 90 days to become fully compliant with the use of HIPAA 5010 transaction standards.

What this means for physicians is that while the implementation date of January 1, 2012, is still in effect, contractors will not reject claims submitted in the 4010 electronic formats until July 1, 2012.

CMA has also surveyed the major payors in California to understand whether they will require claims to be submitted in 5010 format on April 1. While some did require 5010 on January 1, others were allowing for contingencies until April 1. SFMS members will receive a quick reference guide with information on which major payors will require 5010 transactions on April 1 in the March SFMS eNewsletter (due out today).

SFMS/CMA encourages all physicians to continue working with their vendors, clearing houses and billing services to transition to the 5010 format as soon as possible. Offices that transmit directly must ensure their software is updated.

HIPAA Privacy and Security Training Resource

Thu, 19 Jan 2012 09:46:25 GMT

HIPAA mandates that all medical office staff, including physicians, be trained on the HIPAA privacy rules, security policies and procedures. CMA has developed The HIPAA Privacy and Security Rule Training Manual to provide a general training and overview for physicians. The manual contains:

HIPAA Privacy and Security Rule Quiz
Customizable checklist detailing the specific privacy and security rule responsibilities of the employee
Employee certification form

The HIPAA Privacy and Security Rule Training Manual is a joint effort by the California Medical Association (CMA) and PrivaPlan® Associates, Inc. SFMS/CMA members can access this resource free of charge at resource library. Another resource for HIPAA compliance is the CMA/PrivaPlan HIPAA Privacy and Security Compliance Toolkit. The toolkit is customized for California law and contains customized forms, policies and procedures to ensure HIPAA compliance.

Ensure a Smooth Transition to 5010

Fri, 13 Jan 2012 15:15:22 GMT

Health care organizations that submit transactions electronically are required to upgrade from Version 4010/4010A to Version 5010 transaction standards. This mandate applies to anyone covered by the Health Insurance Portability and Accountability Act (HIPAA) and carries a January 1, 2012 deadline. To be compliant, organizations must use version 5010 to send and receive claims and all other HIPAA adopted electronic transactions starting January 1, 2012. CMS Office of E-Health Standards and Services (OESS) has announced that it would exercise its enforcement discretion with respect to any HIPAA covered entity that a complaint is filed against for violation of compliance with Version 5010, and the National Council for Prescription Drug Programs (NCPDP) D.0 and 3.0 standards. The enforcement discretion period is from January 1 to march 31, 2012.

Steps to Ensure a Smooth Transition to 5010

Have a transition plan in place. This plan should document stapes that will be followed and the dates that milestones will be achieved to comply with 5010 requirements. Make your plan available to payers and other business partners so that testing can be scheduled.

Communicate with vendors regularly. Providers should identify areas within their practice that depend on vendor support and communicate with their vendors accordingly to ensure their systems will be up-to-date. Hold vendors accountable by discussing business requirements to ensure products are 5010 compliant. Ask vendors about new 5010 features and request trainings to ensure internal staff is comfortable using the updated system. Lastly, talk to vendors about any contract upgrades or costs involved with implementing the new software.

Reach out to a clearinghouse for assistance. A clearinghouse ensures that claims smoothly transition between practices and payers. When providers submit noncompliant claims, the clearinghouse translates the claims into a compliant format and sends the compliant transaction to payers. The clearinghouse serves as a translator from the 4010/4010A to 5010 format. Even if you normally submit your claims to your business partners directly, a clearinghouse can bridge the gap if you are behind in 5010 implementation, and maintain the submission and processing of your claims while you complete your transition.

Establish a line of credit. Providers should work with their financial team to establish or increase a line of credit to cover potential cash flow disruptions. A line of credit will help a provider’s practice prepare for potential delays and denials in payer claims reimbursements due to noncompliant 5010 transactions being submitted.

Take advantage of the free software available to Medicare Fee-for-Service (FFS) providers via Medicare Administrative Contractors (MACs).

If you have not already done so, SFMS encourage its members to begin testing for 5010 to avoid claim submissions in 2012. Non-compliance with 5010 may also lead to difficulties meeting the October 1, 2013 ICD-10 transition deadline. Please visit www.cms.gov/ICD10 for more information and resources about 5010 and ICD-10.

Physicians: Mobilize Your Practice and Improve Patient Care Delivery

Thu, 15 Dec 2011 12:10:30 GMT

A study conducted by the Joint Commission reported that miscommunication between caregivers during patient hand-offs plays a role in an estimated 80% of serious preventable adverse events. In a time when medical professionals are exploring ways to improve quality of care, why haven’t we tackled the simplest and most cost effective way to achieve this—improving communication? More than 90% of physicians report using a smart phone, and SFMS is excited to announce a new member benefit that leverages this technology to share patient information throughout the local medical community. All SFMS resident and practicing physician members enjoy exclusive and free member-only access to DocBookMD, a HIPAA-compliant smartphone app to connect with local physicians and pharmacies. DocBookMD gives you the entire San Francisco physician database on your mobile devices. You can:

Network with local physicians to develop relationships for referrals
Find colleagues to consult on medical decisions
Obtain second opinion from a fellow colleague immediately—getting a text or email back from a doctor who, in some cases, can save a patient’s life

As an added bonus, all new SFMS member registrations between December 13 and December 20 will be entered into a prize draw for a brand new iPad2.

"I find DocBook to be an extremely useful mobile application that allows me to communicate with my colleagues in a secure manner. In fact, I use it to help colleagues with difficult dermatologic cases that cannot be seen at my office immediately. I am so glad that the San Francisco Medical Society is able to offer this as a free service for its members." —Lawrence Cheung, MD, SFMS Member

To download...

Go to the App Store or Android Market to download DocBookMD. All you need is your SFMS ID number to register for free. Need help locating your ID number? Contact Lauren Estrada at lestrada@sfms.org or (415) 561-0850.

January Deadline Approaching for 5010 Transactions

Mon, 05 Dec 2011 18:01:30 GMT

SFMS is advising physicians to not expect a delay in the 5010 compliance deadline, which is January 1, 2012. All physicians, other health care professionals, payors and clearinghouses that submit HIPAA transactions will be required to use only the 5010 transactions as of the deadline. If physicians are not ready, they risk claim rejections and interrupted cash flow. Use of the 5010 code set applies to electronically submitted administrative transactions, such as checking a patient’s eligibility, filing a claim or receiving a remittance advice.

HOW to prepare for 5010

The biggest concern for practices will be complete implementation and full functionality of 5010 transactions on or before the compliance deadline to avoid transaction rejections and subsequent payment delays. If you have not yet started your conversion process, take action now. The following tips may help you meet the deadline:

Talk to your current practice management system vendor.
Talk to your clearinghouses or billing service (if you use either one) and health insurance payors.
Identify changes to data reporting requirements.
Identify potential changes to existing practice work flow and business processes.
Identify staff training needs.
Test with your trading partners, e.g., payors and clearinghouses.
Budget for implementation costs, including expenses for system changes, resource materials, consultants and training.

What if I’m not ready by the compliance deadline?

Any 4010/4010A1 transactions sent on or after January 1, 2012, will be rejected as non-compliant and will not be processed. CMA has queried the largest payors and published the actions they will take. If you will not be ready by the compliance deadline, talk to your trading partners, e.g., payors, clearinghouses and billing services, to determine what actions you can take to continue having your transactions processed and receive payments. Click here for more information. The Office of E-Health Standards and Services will accept complaints associated with compliance with Version 5010, NCPDP D.0 and NCPDP 3.0 transaction standards beginning January 1, 2012. HIPAA-covered entities that are subject to these complaints must produce evidence of either compliance or an established plan to become compliant within the enforcement discretion period. Complaints may be submitted electronically or via paper.

Would Payors Continue to Accept 4010?

CMA surveyed the major payors in California to find out which of them will continue to accept 4010 transactions beyond January 1, 2012. Click here for the results of which payors will continue to accept 4010 beyond January 1, 2012.

Be Prepared for New 5010 HIPAA Transactions

Tue, 05 Jul 2011 16:18:44 GMT

The deadline for transitioning electronic transactions to the updated 5010 version of the Health Insurance Portability and Accountability Act (HIPAA) transactions standards is January 1, 2012. Physicians will be required to conduct electronic transactions such as claims submissions, eligibility verification, claims status, remittance advice, and referral authorizations using the updated transaction standards. If physicians’ practice management systems are not up to new standards, they will risk not receiving electronic payments from private insurers and Medicare. The new HIPAA 5010 regulations impact all health care providers who:

Send or receive electronic administrative transactions directly to payers—both private and public; and,
Send electronic data to a billing service or clearinghouse that submits transactions on your practice’s behalf.

What is 5010? The new data standards come out of the Health Insurance and Accountability Act of 1996. It demands for more specificity in what data must be entered and transmitted, with the hope that the claims process will be more efficient and more details will be available about the patient visit. For example, physicians must submit a nine-digit, rather than a five-digit, ZIP code on all claims submissions and submit a street address rather than a post office box. 5010 also allows physicians to distinguish between principal diagnosis, admitting diagnosis, external cause of injury, and patient reason for visit codes. Guidelines for Claims Submission Using HIPAA 5010 Standards Step 1: Impact analysis – Conduct an internal analysis to determine the impact the change to 5010 will have on your practice. Step 2: Vendor, payer, billing service, and clearinghouse connections – Contact your practice management and electronic medical record vendor for details on the installation of upgrades to your system. Contact your clearinghouses, billing service, and payers to find out when upgrades will be completed and when they can accept 5010 transactions. Step 3: Installation of vendor upgrades Step 4: Internal testing and staff training – Once the upgrades are completed, conduct internal testing of your systems to ensure you can generate the 5010 transactions. You will need to train staff during the process of implementing and testing your system. Step 5: External testing with clearinghouses, billing service, and payers Step 6: Making the switch to 5010 – After you have completed external testing with some or all of your trading partners, you may switch to using only the 5010 transactions. You are permitted to begin using the 5010 transaction before the compliance date as long as you and the other organizations agree to the early switch. Step 7: Backup plans – In case transaction is rejected after the switch, make a plan for an interruption in cash flow. Some suggestions: Submit as many transactions as possible before January 1, 2012; decrease expenses before January 1, 2012, to increase cash reserves; establish a line of credit with a financial institution. Source: “5010 Implementation Steps: Getting the Work Done in Time for the Deadline,” AMA. Where Can I Find More Information?