X12N (4010/5010)
ICD (9-10-11) GEM

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HIPAA, X12N 4010/5010, ICD 9/10 GEM

CH1: HIPAA Privacy & Security Overview: 1hr viewing time
CH2: HIPAA X12N 5010 Overview: 30m viewing time
CH3: ICD 9-10-11 GEM Overview: 30m viewing time
CH4: Death-Registry Manager: BootHill©™ 5m viewing time
CH5: ICD-GEM Manager: Query©™ 7m viewing time
CH6: ICD-GEM Manager: SuperBill©™ 5m viewing time
CH7: ICD-GEM Manager: Loader©™ 5m viewing time

Health-Care and Health-Care reform affects everyone in the United States. In this educational presentation set of 6 chapters, Tom Dwyer, CHPSP(Certified HIPAA Privacy and Security Professional)*, and president of RedRavenProductions, seeks to demystify the meaning and impact of Health-Care reform legislation for patients and Health-Care entities (Health-Care Entities: Health-Care providers, clearing houses and payers).

Health-Care regulations require a conversion, mapping, translation from ICD-9 to ICD-10 (International Statistical Classification of Diseases and Related Health Problems, 9th, 10th & 11th revision code sets General Equivalence Mapping) has an impact greater than the addition of a few diagnostic and procedural codes. The number of codes expands from roughly 17,000 to 155,000, according to HHS. The ICD 9th revision doesn't have the detail needed for patients' medical conditions or the procedures and services performed on hospitalized patients. The ICD-10 adds sixth and seventh characters and a new structure that allows for further expansion than ever was possible with ICD-9-CM allowing for a greater detail of diagnosis and procedures affecting Health-Care Entity's core processes and technology. In addition, it will impact every business area of an entity who works with coded diagnostic and procedural data. Chapters 2, 3, 5, and 6 simplify what this means for those entities:

CH1: HIPAA Overview. Presents an overview of the 1996 HIPAA (Health Insurance Portability and Accountability Act) for the general public that explains terminology and patient rights, and compliance requirements/deadlines for Health-Care entities (e.g., doctors, dentists, clinics, hospitals, Health-Care laboratories, etc.) It also touches on incentive payments available to Health-Care Entities. . . . . . .more...

Brief History of HIPAA.
Prior to HIPAA the Privacy Act of 1974
The Beginnings of HIPAA
HIPAA Privacy & Security
Titles (I,II,III,IV,V)
Administration Simplification
Privacy & Security Rules
Electronic Health Records
Compliance Timelines (Deadlines for Level I/II compliance)
Penalties (Civil/Criminal)
Transaction Standards and Code Sets (X12/ICD)

CH2: HIPAA ANSI ASC X12N Standards Overview covers the structural/syntax changes and deals with these Key EDI transactions: . . . . . .more...

Structure (004010X0.. and 005010X2.. and 005010X2..E1/A1)
Segments ISA, GS, ST, SE, GE, IEA
Control Numbers, Transaction numbers, EDI Loops
Key EDI transactions
       837: Medical Claims with Subtypes for:
       Institutional, and
       Dental varieties
       820: Payroll Deducted and Other Group Premium Payment for Insurance Products
       834: Benefits Enrollment and Maintenance
       835: Electronic Remittances
       270/271: Eligibility, Inquiry and Response
       276/277: Claim Status, Inquiry and Response
       278: Health Services Review, Request and Reply
ASC X12 Hierarchy
X12A Education
X12C Communications & Controls
X12F Finance
X12G Government
X12I Transportation
X12J Technical Assessment
X12K Purchasing
X12M Supply Chain
X12N Insurance
X12X Steering Committee
X12N Task Groups
TG1 Property and Casualty
TG2 Health Care
TG3 Business & Information Modeling
TG4 Implementation Guides
TG5 Life & Annuity
TG7 Reinsurance
TG8 Architecture
TG11 Education
TG2 Work Groups
WG1 Health Care Eligibility 270, 271, ICHEBI, ICHEBR
WG2 Health Care Claims 837
WG3 Claim Payments 835, 269
WG4 Enrollments And Premium Payments 820, 834
WG5 Claims Status 276, 277
WG9 Patient Information 275
WG10 Health Care Services Review 278
WG15 Provider Information 274
WG12 Interactive Health Care Claims IHCLME
WG20 Insurance Transaction Acknowledgment
WG21 HIPAA Implementation/Coordination

CH3: ICD 9-10-11 GEM Overview covers ICD code format changes and mapping. The International Classification of Diseases, 10th Revision, Clinical Modification, must be used to identify diseases, injuries, impairments, and other health problems. . . . . . .more...

ICD-9-CM Volumes 1 and 2
ICD-9-CM, Volume 3
ICD-10-CM Volumes 1 and 2
ICD Background
ICD Version history
ICD 9/10 CM/CPT Syntax differences, variations, entomologies
ICD-11 versions planned for 2015
A succinct version for use in primary care
A detailed version for use in specialty settings
An advanced version for use in research
Implementation Benchmarks
Health Plans
Project Schedule for Implementation
Impact Assessment on technology, people, processes
Go-Live Plan Preparation Activities

CH4: Death-Registry Manager: BootHill©™ presents a system to be used by Hospitals and companies to track patient expiration information for management. This was the inspiration for the future.

CH5: ICD-GEM Manager: Query©™ explains a system designed to be used by companies to map (or transition) the ICD-9 and ICD-10 codes. It allows users to Look-Up or Query any I9 codes, I10 codes, I9-to-I10 codes and I10-to-I9 codes.

CH6: ICD-GEM Manager: SuperBill©™ explains the charge sheet used by the provider to select the procedures and diagnosis codes that apply to the patient's appointment. The Sheet provides Health-Care providers with a convienient way, without investing in expensive software, to create/modify/map their ICD-9 codes to ICD-10 codes depending on Health-Care Provider specialty, type of rendered services, and additional requirements. It includes a set of obligatory attributes, related to all SuperBill types.

By providing this information, we hope to give the public a general understanding of what is needed to be HIPAA compliant by the next Compliance Dates.

Chick Here for ==> Copyright Notice

NOTICE: Mr.Dwyer/RedRavenProductions©™ is the proprietor of all copyright in a literary-artistic-musical work entitled "ICD-GEM" & "ICD 9-10 GEM" (International Statistical Classification of Diseases and Related Health Problems, 9th revision code set to the 10th revision code set General Equivalence Mapping) Manager-SuperBill-Loader (The "Work"). Mr.Dwyer/RedRavenProductions©™ has reserved all rights in the Work. Initial concept, design and development of the "ICD-GEM Manager©™" began in 1997 and was expressed in material form on March 2 2000. Mr.Dwyer/RedRaven Productions©™ reserves all rights under 17 U.S.C. Section 101 et seq. and infringement on these rights could be liable under the Digital Millennium Copyright Act (DMCA) as set forth in the United States Copyright Act, Title 17 of the U.S. Code, therein.