A recent 5010 assessment at a full-service 300+ bed regional medical facility uncovered a few interesting issues and were somewhat unexpected. MEDITECH was the primary source system for this assessment and was analyzed for the client/server 5.6.4 PP 21 upgrade with its 5010 support and potential impact to the client. The assessment was limited primarily to two HIPAA transactions, the 837I and 835. The client’s financial trading partner, reporting systems, and multiple systems interfaces (57) were also in the mix.
As with any client, fact and assumptions are close companions and an experienced and successful team needs to identify and differentiate between these in the early stages of a project. One could argue that the single most important transaction of the 5010 requirements is compliance with the 837I for a hospital organization and the client is well aware of their compliance - yes, no, maybe? In this case, what was thought to be a fact was not. The consulting team determined based upon thorough interviews of the client’s key personnel and outside validation with the vendors involved that what the client had assumed had been in place for months simply was not implemented. Both the client and the clearinghouse vendor believed a HIPAA compliant 837I transaction was being submitted, when in reality they were dropping UB04 print images to clearinghouse vendor and thus, the “REST OF THE STORY”.
Needless to say, this assessment finding was impactful and valuable for the client not only in identifying a gap to their compliance but saving them both cost and rework with their clearinghouse vendor in the future.
For this particular client the MEDITECH client/server 5.6.4 PP 21 upgrade with its 5010 support and potential impact to the client was scored through our assessment toolkit score card as being 74% compliant. The compliance percentage is an indicator highlighting additional required remediation planning and external partner testing to be completed prior to the Jan. 1, 2012 deadline. As a result of this assessment, our client was prepared for and had a plan now to execute on completing their 5010 migration, understanding the projects, tasks, timing and resources required to successfully meet the deadline.
Lessons learned? Ensure you spend time with your business owners, don’t take assumptions at face value but validate workflows, dataflows, contractual responsibilities with Trading partners and look at the configuration of the applications.
Ben Dyar, Sr. Consultant
Santa Rosa Consulting, Inc.