The HIPPA (Health Insurance Portability and Accountability Act) was enacted by the US Congress in 1996 to improve the portability of healthcare coverage through simplification of healthcare administrative transactions among covered entities. The new 5010 standard, requiring compliance by Jan 1, 2012, and also enabling the transmission of ICD-10 codes, is expected to reduce the individual companion guide requirements and promote consistent implementation across trading partners. Although the implementation of 5010 and ICD-10 is sequential, an impact analysis can be performed for both in the assessment phase of the 5010 transition. This apart, granularity of ICD-10 codes will allow more accuracy in reimbursement payments with improved auto-adjudication, better understanding of quality data, and the potential for improved treatment outcomes. And there can be three broad approaches to handle the 5010 and ICD-10 transition- full service BPO, remediation of the current systems, and replacement with new systems. In all the three cases, appropriate business process and policy changes need to be identified, assessed, planned and implemented. This paper discusses Wipro's 5010 ICD-10 Accelerator Methodology that is designed to specifically address transition challenges and help enterprises leverage the compliance initiative to their strategic advantage. The transition, if approached appropriately, can create a long term positive impact through enabling continuous improvements in operational efficiency, medical expense reduction, customer experience, etc, and help achieve better income and revenue growth.
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