Healthcare reform impact on HIPAA 5010 and ICD-10 remains a mystery

Carl Natale
by Carl Natale

While the healthcare bill ricochets around Capitol Hill, it remains to be seen just how the reform that follows will affect healthcare organizations' conversion to HIPAA 5010 or ICD-10. The bill promotes health IT, in fact, and generally thinking means more financial resources for both HIPAA 5010 and ICD-10, but it also brings certain changes, some of which may lead to greater scrutiny. 

The bill “provides for additional funding to healthcare providers – increased Medicare and Medicaid reimbursements and in the long-term, a higher likelihood that a patient has health insurance – and that will provide additional operating budgets for all projects, IT and otherwise,” explains Eric Brown, a vice president and research director at Forrester Research.

[Podcast: Leveraging ICD-10 to clean up your business. See also: CMS, CDC call for ICD-9 and ICD-10 code freeze. ]

Perhaps that will help healthcare organizations, if only incrementally, to keep pace with the alterations the new bill carries. “There are significant changes to administrative transactions in the health reform bill, including requirements for a national payer ID, electronic claims attachments, and updates to the HIPAA transactions every two years,” explains Stanley Nachimson, co-chair of WEDI's timeline initiative. “There are also certification requirements and additional operating rules.”

While it's still too early to tell exactly how those changes will play out, there is potential for greater investigation into ICD-10 documentation and coding. “My understanding is that there will be more scrutiny because of being more federally controlled,” says Deborah Grider, vice president of strategic development at the American Academy of Coding Professionals (AAPC). “As it is today, we have a lot of scrutiny with our documentation and coding and it may become even more so. That’s one of the unknowns that we’re waiting to find out.”

The imminent conversions to HIPAA 5010 and ICD-10 are bound to trigger new actions and more government involvement will likely follow there as well. “There's every reason to believe the federal government will take a more proactive approach to enforcement,” adds Gale Scott,  HIPAA transaction compliance administrator at Tampa General. “There will be audits.”

Deeper scrutiny and the potential for new audits are among many of the unknowns, to be certain. Indeed, passing a bill into signed law is one thing; putting multitudinous changes into practice and enforcing them where appropriate is another.

“We will have to see how this all turns out,” WEDI's Nachimson says. “Much will depend on how CMS follows through on the implementation.”