Information about http://www.ehcca.com/presentations/HIPAA16/lazarus_t2_1.pdf
1996-2008 The Twelve Year Journey is Not Over STEVEN S.…
Tags: business process, business transactions, cpehr, dartmouth college, data interchange, distinguished service, electronic health records, exchange health, group health, health leadership, himss 2006, information business, leadership award, patient satisfaction, share exchange, steve lazarus, training security, two books, vendor selection, workgroup,Pages: 13
Language: english
Created: Fri Aug 15 23:47:37 2008
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1996-2008 The Twelve Year
Journey is Not Over
STEVEN S. LAZARUS, PHD, CPEHR, CPHIT,
FHIMSS
PRESIDENT, BOUNDARY INFORMATION
GROUP
AUGUST 20, 2008
Steve Lazarus, Boundary Information Group
Health IT Certification, LLC
Strategies for workflow, productivity, quality
and patient satisfaction improvement through
2 health care information
· Business process consultant focusing on
electronic health records, and electronic Strategic IT business
transactions between organizations process planning
· Former positions with MGMA, University of ROI/benefits realization
Denver, Dartmouth College Project management and
· Active leader in the Workgroup for Electronic oversight
Data Interchange (WEDI) Workflow redesign
· Speaker and author (two books on HIPAA Education and training
Security and one on electronic health records) Vendor selection and
enhanced use of vendor
· Recipient of the HIMSS 2006 Book of the
Year Award products
Facilitate collaborations
· Recipient of Vision and Leadership Award as among organizations to
WEDI Chairman, WEDI Corporate share/exchange health
Leadership Award, and WEDI Distinguished
Service Awards care information
EHR and RHIO training
· Consultant to CAQH CORE Project and facilitation
· HIPAA Expert Witness
Copyright Boundary Information Group 2008
Agenda
3
1. Fines are the small stuff
2. HIPAA Transactions and Code Sets
3. The future: 2009-2014
Copyright Boundary Information Group 2008
1. Fines are the Small Stuff: Transactions
4
For providers:
No payment or delayed payment
Remediation cost including legal, IT, and consultants
For health plans:
Loss of key network providers
Complaints to State Insurance Commissioners for lack of
timely payment for clean claims
Remediation legal, IT, and consultants
For clearinghouses
Loss of customers and revenue
1. Fines are the Small Stuff:
Case 1. Providence Health & Services
5
Five security and privacy incidents between
September 2005 and March 2006
386,000 patient electronic records stolen
In 2008, OCR fined Providence $100,000
Corrective action plan
(hhs.gov/ocr/privacy/enforcement/agreement.pdf)
Copyright Boundary Information Group 2008
1. Fines are the Small Stuff:
Case 1. Providence Health & Services
6
Potential state fines (four states)
Internal remediation
Replace fired staff
ID theft repair service for one year for 386,000
patients
Consultants and lawyer fees to audit, support
remediation and provide legal counsel
Repair public reputation
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1. Fines are the Small Stuff: Case 2. Olson vs.
ASEA/AFSCME Local 52 Health Benefits Trust
7
July awarded $275,000 to Olson
Legal costs exceeded $1.6 M
Key documents relied on for expert testimony
The written duties and responsibilities of Trustees document
which they signed when they become
trustees(http://www.asaehealth.org/servlet/content/130.htm
l)
Trust policy on privacy
(http://www.asaehealth.org/servlet/content/1131.html)
Copyright Boundary Information Group 2008
2. HIPAA Transactions and Code Sets
8
1991: HHS Secretary Sullivan forms WEDI to study cost
savings from EDI
1992 and 1993: WEDI completes WEDI reports
recommending use of EDI standards and law requiring use
1996: HIPAA legislation becomes law
1998: Transaction and Code Sets NPRM published
2003: Use of HIPAA Standard Transactions and Code Sets
required for all electronic standard transactions
2003: ASCA legislation requires most Medicare claims be
filed electronically using the HIPAA standard
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2. HIPAA Transactions and Code Sets
9
2004: Standard Employer Identifier use required
2006: CORE Phase I Rules approved for eligibility
electronic transactions (www.caqh.org)
2008: National Provider Identifier (NPI) use
required for electronic transactions
2008: CORE Phase II Rules approved for
eligibility and claim status inquiry transactions
Copyright Boundary Information Group 2008
3. The Future: 2009-2014
10
Future expectations
2008 HIPAA 2 Transactions and Code Sets NPRM
2008 ICD 10 NPRM
2012-2014 use of 5010 ACS X12 and the following
NCPDP transactions:
Telecommunication Standard Implementation Guide V D.0
Batch Standard Implementation Guide Version 1.2
Medicaid Subrogation Standard Implementation Guide V 3.0
2009-2014 may require use of electronic claims
attachment transaction standard
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3. 2010 or so: Business Use Cases Drive all New
Transactions and Code Sets
11
Most transactions in real time, except for claims and
remittance advice
Auto adjudication of claims?
Convergence of administrative and clinical information
electronic exchanges
Move from transcription-based standards to
information exchange standards
Industry moves from "compliance" to a revenue cycle
improvement approach for information exchange
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3. Incentives to Adopt Revenue Cycle
Management Approach
12
Voter/congressional pressure on Medicare Part B premium
increases
Global healthcare competition
Prescription and nonprescription drug imports
Non-life threatening surgery
Distance diagnostic testing
Consumer transparency
Medical banking
Global economy
Politics
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Contact Information
13
Steven S. Lazarus, PhD, CPEHR, CPHIT, FHIMSS
(303) 488-9911
sslazarus@aol.com
Boundary Information Group
www.boundary.net
Health IT Certification, LLC
www.healthitcertification.com
Copyright Boundary Information Group 2008