Some Healthcare and IT tidbits from this week…
+ Proposed ICD-10 Delay of Compliance Date for One Year
+ Health Data Protection and Requirements to Share Information
+ HHS gives 6 more states $181M in HIX funding
+ AMA calls for 2-year extension of ICD-10 deadline
+ No Surprise, but Health Care Costs This Year May Exceed Annual Mortgage Payment
TGIF!
Thomas Derrick, President
MariChris, LLC
Does your organization need to ensure:
+ Compliance with the Health Care Affordability Act of 2012
+ Lower Product Delivery Cost
+ Increased Product Quality
+ LifeCycle Traceability and CMS Certification Compliance
+ Better Health Outcomes
+ A Better Future for Your Healthcare Customers?
Today’s healthcare solutions are expensive, unpredictable, and shrouded in a future of uncertainty. Ever-changing regulations, demanding requirements, stringent eligibility qualifications, complex reimbursement tracking, and the need for Federal certification create a complex environment within which we, as healthcare professionals, must operate.
MariChris removes the complexity and provides you with reliable, sustainable solutions.
Our healthcare eligibility determination solutions, UnivERS, is fully compliant with all known and anticipated MITA 3.0 eligibility determination requirements. It’s flexible eligibility determination rules engine allows administrators, (not expensive technicians) to configure the rules for any eligibility program, benefit plan, waiver, or carve-out.
Through TraceIT, we offer the only integrated requirements traceability and CMS certification solution on the market providing complete support throughout all phases of the system development life cycle (SDLC). Our technology-oriented solutions ensure that healthcare professionals and health insurance companies will meet market demands now and in the future.
Through the products and services described on our web-site, MariChris stands ready, willing and able to guide you through the complex world of eligibility determination and CMS Certification compliance, including all aspects of the entire system development life cycle (SDLC).
Contact us today for a product brochure, fully service product discussion, or a comprehensive system demonstration.
Thomas Derrick, President
MariChris, LLC
Why wait until 2014 ~ MariChris LLC is ready today!
Until the Supreme Court issues its constitutionality ruling, health insurance exchanges or “marketplaces” seem to be “processing,” or not, based on political party lines.
According to a Washington Post article:
“In states with Democratic governors, such as New Hampshire and Minnesota, it is often Republican-dominated legislatures that are causing the hold-up. And in six states where Republicans hold both branches of government, including Kansas and South Dakota, state assemblies haven’t even considered laws to establish the marketplaces.”
There have been some exceptions. The Republican governor of Nevada chose not to stand in the way of an exchange bill and the Republican insurance commissioner of Mississippi is using existing authority to set up an exchange with the blessing of the Republican governor. Democratic lawmakers in Arkansas as example — have proved unwilling to push for an exchange.
The controversy continues – even as we wait for a final ruling from the Supreme Court expected before the end of June 2012. But even that “final” may not be final – as some will still be hedging their bets until after the elections in November 2012 at which time the law could still face repeal.
Guess wrong and don’t have your exchange well underway by January 1, 2013? You’ll face the threat of a Federal takeover…
Thomas Derrick, President
MariChris, LLC
NPI stands for “National Provider Identifier.”
NPIs replaced the unique provider identification number (UPIN) as the required identifier for Medicare services, and is used by other payers, including commercial healthcare insurers. The transition to the NPI was mandated as part of the Administrative Simplifications portion of the Health Insurance Portability and Accountability Act of 1996 (HIPAA.) CMS began issuing NPIs in October 2006.
HIPAA covered entities such as providers completing electronic transactions, healthcare clearinghouses, and large health plans were required by regulation to use only the NPI to identify covered healthcare providers by May 23, 2007.
The NPI was proposed as an 8-position alphanumeric identifier. However, many stakeholders preferred a 10-position numeric identifier with a check digit in the last position (the first 9 positions are the identifier and the last position is a check digit) to help detect keying errors. The NPI contains no embedded intelligence; that is, it contains no information about the health care provider, such as the type or location of the health care provider.
Some interesting Healthcare/IT news from this week:
+ CMS seeks tools to verify income data for exchanges
+ Groups Offer Input on Proposed Delay for ICD-10 Compliance
Definition: CPOE – Computerized Physician Order Entry
+ ONC privacy and security guide offers 10 steps for MU
Definition: MU – Meaningful Use
+ HIPAA changes could put tech companies on the hook
TGIF!
Thomas Derrick, President
MariChris, LLC
Interesting opinion piece this morning from Computing.co.uk entitled:
“Information is the lifeblood of healthcare”
“Technology can “connect the dots” of data that have the power to reduce costs and enhance care. It’s true that projects like the NHS’s National Programme for IT fell short of expectations, but the truth remains that systems that don’t talk to each other to share patient information create costly silos.
Read the rest of the article here.
It’s easy to get knee-deep in schedules and deadlines, rules and regulations, etc., etc. and at the same time – forget that the purpose of HIPAA, ACA, and most of the other acronyms on our “Definitions” page is to make healthcare more efficient and successful, more available, and more affordable.
Thomas Derrick, President
MariChris, LLC
On March 15, 2012, the Centers for Medicare & Medicaid Services’ Office of E-Health Standards and Services (OESS) announced that it would not initiate enforcement action for an additional three (3) months, through June 30, 2012, against any covered entity that is required to comply with the updated transactions standards adopted under the Health Insurance Portability and Accountability Act of 1996 (HIPAA): ASC X12 Version 5010 and NCPDP Versions D.0 and 3.0.
The bad news is that, incredibly, nearly half of this discretionary extension window has already expired.
For any entity or state having difficulties with program readiness and implementation, contact info is available from the Department of Health and Human Services, Centers for Medicare & Medicaid Services – email addresses via this link.
Council on Affordable Quality Healthcare – A entity authorized by DHHS for operating rule changes under ACA.
This is a sub-committee of the Committee on Operating Rules for Information Exchange (CORE) and the National Council for Prescription Drug Programs (NCPDP.)
Authorized per:
Administrative Simplification: Adoption of Operating Rules for Eligibility for a Health Plan and Health Care Claim Status Transactions – DEPARTMENT OF HEALTH AND HUMAN SERVICES, 45 CFR Parts 160 and 162.
SUMMARY: “Section 1104 of the Administrative Simplification provisions of the Patient Protection and Affordable Care Act (hereafter referred to as the Affordable Care Act) establishes new requirements for administrative transactions that will improve the utility of the existing HIPAA transactions and reduce administrative costs.”
Read the full Federal Register rules and regulations regarding this sub-committee.
More about CAQH and its initiatives.
How does the ACA – Affordable Care Act impact eligibility for Medicaid?
Creates a new Medicaid group – Newly Eligible Individuals age 19-64 who:
+ Have income below 133% FPL (138% FPL with a 5% disregard)
+ Meet citizenship requirements
+ Are not incarcerated
+ Are not entitled to Medicare
Changes to income and deductions for existing Medicaid groups:
+ Children
+ Pregnant Women
+ Families (Parents/Caretaker Relatives)
Modified Adjusted Gross Income (MAGI) methodology used for income calculation is the IRS
+ Countable income
+ Income deductions
Additional methods for determining income and deductions
+ Household composition – mirrors federal income tax filing rules
+ No asset/resource limits
+ 12 month certification periods
Simplified application and renewal process for:
+ Medicaid
+ Children’s Health Insurance Program (CHIP)
+ Health Benefit Exchange
The following groups will not have any changes in eligibility for Medicaid:
+ Aged, Blind or Disabled individuals
+ Foster Care children
+ SSI cash recipients
Contact us today to find out about UnivERS, the MariChris LLC medicaid eligibility custom rules engine.
Thomas Derrick, President
MariChris, LLC
