Tuesday, July 5, 2011

How the 5010 Standard Will Affect Long Term Care Providers and Billing

As announced by the U.S. Department of Health and Human Services (HHS) on January 16, 2009, updated versions of the Health Insurance Portability and Accountability Act (HIPAA) transaction will be required to be used by providers beginning on January 1, 2012. The HIPPA standards for electronic health care transactions are changing from version 4010/4010A1 to version 5010. The Centers for Medicare and Medicaid Services (CMS) oversaw compliance with these standards and this is required by federal law.

The 5010 consists of a new set of standards regulating the electronic transmission of specific healthcare transactions. These transactions include claims, remittance advices, and requests and responses for eligibility and claims status. The 5010 transactions report electronic claims, electronic eligibility verification, electronic claim status, electronic referral certification and authorization, electronic remittance, and more. The 5010 standards will increase transaction consistency, support pay-for-performance, and streamline reimbursement transactions.

Those who are required to upgrade to the 5010 standard include a range of health care providers, including long-term care providers. In this regard, the implementation may change the software, systems and procedures already used for billing Medicare and other such payers. The 5010 will ensure that insurance companies receive accurate bills in the correct data and formats. LINTECH’s COMET application for long-term care billing is set to assure its users that their submissions will be in full compliance with the 5010 requirements.

Healthcare providers who fail to use only the 5010 transactions as of the January 1, 2012 deadline risk claim rejections and interrupted cash flow. Anyone who already electronically submits transactions, such as checking a patient’s eligibility, filing a claim, or receiving a remittance advice, will be automatically updated to the current version.

COMET Point-of-Care (Touchscreen) Application

Technology is on a never-ending journey as new devices, tools and applications are created to provide better alternatives for people everywhere. Long-term care for nursing home residents requires documenting information in order for nurses and staff to provide the residents with accurate care. Compared to the traditional usage of papers to track data, LINTECH launched the new COMET Point-of-Care (Touchscreen) application, which provides a faster and more organized data entry system, benefiting both residents and staff.

With this application, staff can spend less time entering data and more time concentrating on nursing home residents. In addition, the application saves in costs and workflow. The Point-of-Care application greatly reduces the likelihood of data entry errors from occurring.

The Point-of-Care application uses a picture icon for each of the nursing home’s residents, which makes it easier for nurses and staff members to verify that they are entering data on the correct electronic file. Even for those who are far from being technology savvy, the Point-of-Care application is extremely user friendly. Anyone who is using an ATM machine can use this application.

With LTC software benefiting nursing home residents and staff already, the Point-of-Care (Touchscreen) application is the perfect addition.

EMR Software Benefits Nursing Home Residents More Than Hospital Patients

Health information technology (HIT) assists caregivers in providing quality care to patients through electronic medical record (EMR) software. Among other things, EMRs help prevent harmful drug interactions, tracks assessments and monitors clinical outcomes. EMRs also track billings and reimbursements thus reducing paperwork redundancies. It is expected that within the next five years, the growth in EMR systems will rise about 15% annually. The focus of an EMR is not to just make it more convenient for health care providers to retrieve patient medical records, have better storage and allow for easy modifications, but to spend more time in caring for patients. While both acute care and long-term care facilities utilize EMR to provide better care for their patients and residents, the usage and emphasis of nursing home EMR is somewhat different than in hospitals.

Hospitals focus on short-term acute care for those of all ages, whereas nursing homes provide care for residents who are typically older and stay a longer period. Fifty percent of nursing home residents stay for at least one year and 21% stay for five years. In addition, not many realize that a long-term care (LTC) setting is much different as compared to a hospital. Differences include the staffing ratios, staff trainings, and care management and systems, among other things.

Nursing home residents take roughly eight medications a day to help with varying conditions, the majority being chronic conditions. A hospital patient, however, is most likely given a prescription pill to take for a certain period of time to cure a short-term health problem. Therefore, EMRs for LTC facilities need to be set up to respond to LTC’s unique setting.

In 2005, Rainu Kaushal, MD, MPH, and colleagues from Brigham and Women's Hospital in Boston conducted the study “Functional Gaps in Attaining a National Health Information Network," in which they assessed that there is a 1% adoption of EMRs in skilled nursing facilities. This is significantly smaller compared to the use of EMRs in hospitals, which have an 18% penetration rate. While in recent years the adoption rate of EMRs by LTC facilities has grown significantly, there is no doubt that EMRs in long-term care have still a long way to go.