HIPAA Version 5010 National Testing Day
The Centers for Medicare & Medicaid Services (CMS), in conjunction with the Medicare Fee For Service Program, responded to MGMA’s request and announced a National 5010 Testing Day to be held Wednesday, June 15, 2011. Practices must adopt the latest version of the HIPAA electronic transaction standards, Version 5010, by Jan. 1, 2012. These electronic transaction standards include claims, insurance eligibility verification, remittance advice and others. Practices should be taking steps now to get ready, including conducting internal and external testing with practice management system software vendors, clearinghouses and health plans.
National 5010 Testing Day is an opportunity for trading partners to work together and test compliance efforts that are already underway with the added benefit of real-time help desk support, and direct and immediate access to Medicare Administrative Contractors (MAC). Your local MAC will provide more details concerning transactions to be tested soon. Several State Medicaid Agencies are expected to participate in the National 5010 testing day.
More information on HIPAA Version 5010 is available on the CMS http://www.cms.gov/and MGMA (http://www.mgma.com/) websites.
Anesthesia Compliance Plans; Seven Keys to Success
The complexity of federal and state programs make a compliance program essential for all group practices. Your compliance plan implemented well and maintained through regular meetings and communications is your main line of defense, should your group become the focus of an audit. Without a compliance plan, you will be at the mercy of the payers and should expect huge penalties, potential revocation of Medicare provider certification and even jail time. There is no reason to take the associated risk. Consider compliance a regular part of doing business and invest the energy and resources required to sleep well at night knowing that your risk has been reduced.
Seven Keys to Compliance Success
- Internal monitoring and auditing needs to be performed on a scheduled basis by well trained and experienced auditors.
- There should be clearly written and well communicated compliance program and practice standards.
- Designate a compliance officer.
- Maintain a high quality training and education program for all staff members.
- Insure that the lines of communications are open and allow concerned employees to speak freely, without fear of reprisals.
- If a problem is identified, have a plan of action to investigate, and take corrective action if required.
- Enforce the compliance plan without exception.
Anesthesiologists should be aware of areas that will draw attention from governmental payers and Recovery Audit Contractors (RACs). Facet injections have been the subject of recent OIG reports. Anesthesia start and stop times and protocol for transfer of care have received recent attention from governmental payers also.
