530-195 HIPAA Transaction Standards (1).ppt - Healthcare...

Unformatted text preview: Healthcare Reimbursement HIPAA Transaction Standards HIPAA Overview HealthInsurance InsurancePortability Portability Health andAccountability AccountabilityAct Actof of and 1996 1996 Title I Title I Healthcare Access, Healthcare Access, Portability, Portability, Renewability Renewability TitleIIIISubtitle SubtitleFF Title Administrative Administrative Simplification Simplification Title III Title III Tax Related Tax Related Health Health Provisions Provisions Title IV Title IV Application & Application & Enforcement of Group Enforcement of Group Health Plan Health Plan TitleVV Title Revenue Revenue Offsets Offsets Administrative Simplification HealthInsurance InsurancePortability Portability Health andAccountability AccountabilityAct Actof of and 1996 1996 Title I Healthcare Access, Portability, Renewability Transaction Transaction Standards&&Code Code Standards Sets Sets TitleIIIISubtitle SubtitleFF Title Administrative Administrative Simplification Simplification UniqueHealth Health Unique Identifiers Identifiers Title III Title IV Tax Related Health Provisions Application & Enforcement of Group Health Plan Privacy Privacy Legislation Legislation Security&&Electronic Electronic Security SignatureStandards Standards Signature Title V Revenue Offsets Transaction Standards & Code Sets Eight transaction standards Code sets for data elements Final Effective Compliance Aug 2000 Oct 2000 Oct 2002 Transaction Standards There are 8 transaction standards - ANSI- ASC X12 transaction standards and implementation guides for health claims communication, enrollment and payment. – ANSI is the American National Standards Institute Transaction Standards 837 – Health Care Claim Dental, Professional, and Institutional 270/271 – Health Care Eligibility Benefit Inquiry and Response 278 – Health Care Services Review – Request for Review 276/277 – Health Care Claim Status Request and Response 834 – Benefit Enrollment and Maintenance 835 – Health Care Claim Payment/Advice 820 – Payroll Deducted and Other Group Premium Payment for Insurance Products Referral certification & authorization First report of injury (will not be included in Final Rule) Health claims attachments (will not be included in Final Rule Code Sets Types of code sets involved: Two types of code sets are required for data elements in the transaction standards to be established under HIPAA. – Large code sets for medical data, including coding systems for procedural and diagnostic encounters. – Smaller sets of codes for data elements such as race, ethnicity, type of facility, type of unit. The smaller code sets are being integrated into the transaction standards themselves and are specified in their implementation guidelines. Code Sets ICD-9-CM and ICD-10-CM/PCS CDT – Code on Dental Procedures and Nomenclature HCPCS – Excludes HCPCS level III codes CPT-4 NDC – National Drug Codes NCPDP – National Council for Prescription Drug Programs Current HIPAA Designated Code Sets Provider Facility Inpatient Facility Outpatient Physician Code Sets Diagnosi Procedure s ICD-9-CM ICD-9-CM ICD-9-CM ICD-9-CM CPT/ HCPCS Level II* CPT/ HCPCS Level II * NOTE many facilities still assign ICD-9-CM procedure codes in the OP areas for statistical reasons; they may not, however, be used for billing. ICD-10 Implementation CMS published the final rule calling for implementation of ICD-10-CM & ICD-10-PCS as the replacement for ICD-9-CM as of 10/1/2014 – ICD-10-CM will replace volumes 1 & 2 of ICD-9-CM for diagnosis reporting for all healthcare settings and providers – ICD-10-PCS will replace volume 3 of ICD-9-CM for procedure reporting for hopsital inpatient services For more information on the transition to ICD10 go to HIPAA Designated Code Sets AFTER CD-10 Implementation Code Sets Provider Diagnosi s Facility ICD-10-CM Inpatient Facility ICD-10-CM Outpatient Physician ICD-10-CM Procedure ICD-10-PCS CPT/ HCPCS Level II CPT/ HCPCS Level II ...
View Full Document