ANSI 5010

ANSI 5010 defines the new standards for HIPAA transactions
• Replaces 4010A = HIPAA Accredited Standards Committee (ASC) X12 Version 4010A
• Implements more than 500 changes requested by the healthcare industry.
• Improves healthcare data transaction efficiency.
• Affected transactions include claims, remittance, eligibility, claims status requests, and response.
• Affects many health care entities including Suppliers/Providers, Health Plans, Clearinghouses, Billing Services, and Software Vendors.
• Will require changes to software, systems and procedure.
• This change will be implimented in conjunction with National Council for Prescription Drug Programs (NCPDP) version D.0.
• Full compliance required by January 1, 2012

Meaningful use

The American Recovery and Reinvestment Act of 2009 specifies three main components of Meaningful Use:
1. The use of a certified EHR in a meaningful manner, such as e-prescribing.
2. The use of certified EHR technology for electronic exchange of health information to improve quality of health care.
3. The use of certified EHR technology to submit clinical quality and other measures.
Simply put, “meaningful use” means providers need to show they”re using certified EHR technology in ways that can be measured significantly in quality and in quantity.

ARRA (American Recovery and Reinvestment Act)

On Feb. 17, 2009, Congress passed the American Recovery and Reinvestment Act of 2009 at the urging of President Obama, who signed it into law four days later. A direct response to the economic crisis, the Recovery Act has three immediate goals:
• Create new jobs and save existing ones
• Spur economic activity and invest in long-term growth
• Foster unprecedented levels of accountability and transparency in government spending
The Recovery Act intended to achieve those goals by:
• Providing $288 billion in tax cuts and benefits for millions of working families and businesses*
• Increasing federal funds for entitlement programs, such as extending unemployment benefits, by $224 billion*
• Making $275 billion available for federal contracts, grants and loans*
• Requiring recipients of Recovery funds to report quarterly on how they are using the money. All the data is posted on so the public can track the Recovery funds.
In addition to offering financial aid directly to local school districts, expanding the Child Tax Credit, and underwriting the computerization health records, the Recovery Act is targeted at infrastructure development and enhancement. For instance, the Act provides for the weatherizing of 75 percent of federal buildings and more than one million private homes.
Construction and repair of roads and bridges as well as scientific research and the expansion of broadband and wireless service are also projects that the Recovery Act is funding.
While many of Recovery Act projects are focused on jumpstarting the economy, others, especially those involving infrastructure improvements, are expected to contribute to economic growth for many years.


EHR (Electronic Health Record)

An Electronic Health Record (EHR) is an electronic version of a patients medical history, that is maintained by the provider over time, and may include all of the key administrative clinical data relevant to that persons care under a particular provider, including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports The EHR automates access to information and has the potential to streamline the clinician”s workflow. The EHR also has the ability to support other care-related activities directly or indirectly through various interfaces, including evidence-based decision support, quality management, and outcomes reporting.
EHRs are the next step in the continued progress of healthcare that can strengthen the relationship between patients and clinicians. The data, and the timeliness and availability of it, will enable providers to make better decisions and provide better care.
For example, the EHR can improve patient care by:
• Reducing the incidence of medical error by improving the accuracy and clarity of medical records.
• Making the health information available, reducing duplication of tests, reducing delays in treatment, and patients well informed to take better decisions.
• Reducing medical error by improving the accuracy and clarity of medical records.

ICD-10 (International Classification of Diseases, 10th Edition)

ICD-10 (International Classification of Diseases, 10th Edition)

The ICD is the international standard diagnostic classification for all general epidemiological, many health management purposes and clinical use. These include the analysis of the general health situation of population groups and monitoring of the incidence and prevalence of diseases and other health problems in relation to other variables such as the characteristics and circumstances of the individuals affected, reimbursement, resource allocation, quality and guidelines.


NCPDP (National Council for Prescription Drug Programs)

The mission of NCPDP (National Council for Prescription Drug Programs) is clear: to create and promote data interchange standards for the pharmacy services sector of the health care industry, and to provide information and resources that educate the industry and support the diverse needs of our members. As needs within the industry are identified, standards are updated to a new version or release. The following is a high-level overview of the latest version/release and/or the most commonly used of those standards and implementation guides, as well as NCPDP’s Data Dictionary and External Code List. Additionally, this document provides version/release/publication reference charts for approved and draft NCPDP standards/implementation guides.


HIPAA (Health Insurance Portability and Accountability Act)

HIPAA: Health Insurance Portability and Accountability Act

The HIPAA Privacy Rule provides federal protections for personal health information held by covered entities and gives patients an array of rights with respect to that information. At the same time, the Privacy Rule is balanced so that it permits the disclosure of personal health information needed for patient care and other important purposes.
The Security Rule specifies a series of administrative, physical, and technical safeguards for covered entities to use to assure the confidentiality, integrity, and availability of electronic protected health information.