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5010 planning and implementation: The time for action is now
Health care payers and providers contemplating their approach to phasing in ASC X12 5010 standards as required by the Health Insurance Portability and Accountability Act (HIPAA) may think that they have plenty of time between now and the Jan. 1, 2012, compliance date. However, they may be in for a rude awakening, according to Larry Watkins, managing consultant at Ingenix Consulting.
"There is a misconception that the 2012 date is what payers and providers should focus on," Watkins said. "While the implementation deadline seems distant, these organizations can't be complacent. Their first 5010 deadline is much earlier," he said, referring to benchmarks that must be met in 2010 and 2011.
"By Dec. 31, 2010, payers and providers must have completed the first level of testing," he explained. "To meet this deadline, payers and providers really must begin their 5010 design build today and conduct internal testing throughout 2010. Once these organizations realize that Level Two testing must be completed by the end of 2011, the final compliance dates don't appear to be so far away." Click here to continue reading this article online. (11/17)
Controlling fraud, abuse and waste could help fund health reform priorities
Advocates for improving health insurance coverage access and affordability believe that curtailing waste, fraud and abuse could help slow the growth of overall health care costs (which are predicted to double by 2018), ensure that spending is focused on providing appropriate health care services, and restore confidence in the system.
Helping to curtail inappropriate payments could save a great deal of money. The National Health Care Anti-fraud Association (NHCAA) estimates that 3% of all health care spending is lost to health care fraud; with the figure even higher in public health programs. The Federal Bureau of Investigation has estimated fraudulent billings to health care programs, both public and private, at between 3% and 10% of total health care expenditures.
"Regardless of which estimate is used -- and to be honest, both of these may be a bit conservative -- there is no question that there is money to be saved by preventing health care fraud, abuse and waste," said Gerry Hill, senior project manager, Fraud and Abuse Protection, at Ingenix. Click here to continue reading this article online. (11/04)
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