Pilot for End-to-End Testing of Compliance with Administrative Simplification. Presented By: National Government Services

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1 Pilot for End-to-End Testing of Compliance with Administrative Simplification Presented By: National Government Services

2 Industry Collaborative Partners Introductions Aetna American Health Insurance Plans (AHIP) American Hospital Association (AHA) American Medical Association (AMA) CMS Medicaid CMS Medicare Fee For Service Emdeon Healthcare Billing & Management Association (HBMA) IVANS Medicaid CSG Government Solutions Medical Group Management Association (MGMA) Nachimson Advisors, LLC Providence Health and Services TIBCO Foresight TRICARE UNC Health Care Walgreens WellPoint Veteran s Affairs 2

3 Goals The goals of the pilot are: To develop and implement a process and methodology for End-To-End testing of the transaction standards, operating rules, code sets, identifiers, and other Administrative Simplification requirements adopted by the Secretary of Health and Human Services (HHS) under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Patient Protection and Affordable Care Act of 2010 (ACA) based on industry feedback and participation. To develop an industry wide Best Practice for End-to-End Testing that lays the ground work for a more efficient and less time consuming method for health care provider testing of future standards, leading to more rapid adoption of the future standards. 3

4 Intended Outcomes The intended outcomes of the pilot are: To provide documents and artifacts to all industry segments outlining the critical check-points needed to ensure compliance with the current mandates To provide documents and artifacts to all industry segments outlining the critical check-points which can be used as foundations with future mandates To provide a universal testing process and methodology that can be adopted by all industry segments To provide a framework and common understanding around the End-To-End testing process and definitions 4

5 Overview Phase I Business and Gap Analysis started on September 24, 2012 and will run through December 21, 2012 (Completed) Phase II - Development of Pilot Testing started on December 10, 2012 and will run through June 27, 2013 (approximately six months)* The planned start date for Phase III - Implementation and Quality Assurance is July 1, 2013, and will run through September 23, 2013 (approximately three months)* *Actual dates are subject to change during detailed schedule development 5

6 End-to-End Testing The intended outcome of our pilot is to analyze, develop and demonstrate a process and methodology which ensures compliance with legislative mandates and regulations. Based upon discussion and feedback from professional organizations, such as Workgroup for Electronic Data Interchange (WEDI), Healthcare Information and Management Systems Society (HIMSS), North Carolina Healthcare Information Communications Alliance (NCHICA), Healthcare Billing & Management Association (HBMA) and other Associations, there has been strong recommendation that the Industry clearly needs a standard definition for End-To-End testing which is acceptable throughout the Health Care Industry. *Our final definition is as follows: End-to-End testing is a focused process within a defined area, using new or revised applicable products, operating rules or transactions, throughout the entire business and/or clinical exchange cycle, for the purpose of measuring operational predictability and readiness. The End-to-End testing process should be performed in an environment which mirrors actual production as closely as possible, confirming the validation of performance metrics and analytics (reporting). *This is a catalyst from our initial discussion with our Industry Collaborative Partners for establishing a definition of End-To-End testing based on Industry feedback and participation during Phase I of our pilot. 6

7 Readiness Readiness is a state of preparedness that includes defining needs, identifying risk and implementing a planned sequence of actions to successfully operate and maintain a new/upgraded system, and or processes, with each published standard by the regulatory implementation date. *Our revised definition is as follows: Readiness is a state of preparedness in which an Entity has completed verification and validation of applicable policies, procedures, guidelines, laws, regulations, and contractual arrangements with expected results. Additionally, entities will demonstrate readiness by completing internal documentation, establishing communication mechanisms and validation with external trading partners, training of appropriate personnel, scheduled deployments, and software migration for each regulatory requirement. *This is a catalyst for our initial discussions with our Industry Collaborative Partners for establishing a clearly refined definition of Readiness based on Industry feedback and participation on January 10, 2013 webinar. 7

8 Compliance *Our revised definition is as follows: Compliance is a demonstrated adherence to those policies, procedures, guidelines, laws, and regulations to which the business process is subject in advance of, by, and continued support after, the regulatory implementation date. *This is a catalyst for our initial discussions with our Industry Collaborative Partners for establishing a clearly refined definition of Compliance based on Industry feedback and participation on January 10, 2013 webinar. 8

9 Suggested Audience for Listening Session Definitions Small providers will include small/medium sized organizations comprised of 99 or less physicians/staff, independent practices, dentists, durable medical suppliers, pharmacy, home health agencies/hospices and specialty practices. Large providers will include organizations comprised of 100 or more physicians/staff, clinical labs, hospitals, critical access hospitals, nursing homes, rehab centers, skilled nursing facilities, ambulatory surgical centers, pharmacy and Federally Qualified Health Centers (FQHC). Payers will include organizations comprised of Commercial, Medicaid, Medicare, Pharmacy Benefit Management (PBM) and Workers Compensation Government Contractors. Vendors will include organizations comprised of Billing Services, Clearinghouses, Electronic Health Record/Electronic Medical Record Systems, Network Service Vendors, Practice Management Systems and Value Added Networks. 9

10 How to contact us All questions may be sent to Our expected level of service is to acknowledge all s within 24 hours Additional Contact Resources: 10

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