Hospital Management Database Flow Diagram by xtb55663

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									                         Process Flow

   Forms
                                                        `                   `




                     `                  Document(s)         Document(s)




  Personnel




                           Data Store   Process(es)         Process(es)




  ?           NPI Data
                File




                                          Data                  Data
                                         File(s)               File(s)




                     `
Providers

                                        Data Store(s)       Data Store(s)
                                     ASSESSMENT WORKSHEET NARRATIVE




The attached assessment worksheet is to be used, in conjunction with the Process Flow Diagram, for each of
the identified NPI impacted systems to identify the following:


   1) From where is Provider Information received?

   2) How is Provider Information stored?

   3) How is Provider Information used?

   4) How is Provider Information used the IT process?

   5) How is Provider Information used in any outputs from the IT process?

 For each step above both the technical and non-technical impacts will be assessed.



The attachment assessment worksheet is to also be used to identify the following:



 1) Are there any Non-IT Provider Information impacts that exist that are not associated to a specific IT process?


 2) Are there any other Business Level Provider Information documentation/communication issues?
                                                                                PROCESS FLOW WORKSHEET

        DHHS NPI Initiative

        Division/Office/Facility:
        System/Category:
        Contact Name(s):
        Date:



   1    Provider Information is received:

   2        Staff personnel entry


                  Has appropriate staff been identified for collection of
   3
                  NPI/Taxonomy?


                  Does additional staff need to be acquired for collection of
   4
                  NPI/Taxonomy?

                  Will NPI staff need to be instructed on how to collect and store the
   5              initial collection of NPI/Taxonomy? (e.g., form, interview, phone
                  call, etc.)

                  Will screens need to be developed or modified for NPI and
   6
                  Taxonomy?



   7              Will NPI/Taxonomy need to be validated/authenticated?



                  Will NPI staff need to be instructed on how to collect and store
   8
                  NPI/Taxonomy on an ongoing basis?


                  Will current and ongoing procedures for NPI/Taxonomy collection
   9
                  need to be documented?



   10



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                                                                                  PROCESS FLOW WORKSHEET


   11       Form entry


                 Will a form need to be developed or modified for collecting
   12
                 NPI/Taxonomy?


                 Is there documentation associated to this NPI/Taxonomy
   13
                 information form that will need to be updated?


                 Where will this NPI/Taxonomy information form be made
   14
                 available? (e.g., via mail, web, internal use only, etc.)



   15



   16      Data file interface



   17            From where will this NPI information file come?



   18            Who will receive this NPI information file?



   19            Will Taxonomy need to be included on this NPI information file?



   20            What process will be used to access this NPI information file?



                 Will communication need to be established with the creator of this
   21
                 NPI information file? (i.e., layout, availability, accessibility, etc.)


                 Will an NPI information file maintenance schedule need to be
   22
                 established?




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                                                                                 PROCESS FLOW WORKSHEET



   23



   24        Direct Provider entry


                 Will screens need to be developed or modified for the initial
   25
                 collection of NPI/Taxonomy?


                 Will screens need to be developed or modified for the ongoing
   26
                 maintenance of NPI/Taxonomy?



   27            Will NPI/Taxonomy need to be validated/authenticated?



   28


   29   Provider Information is stored:
   30        Provider database

   31          Division Level


                 Will a division provider database need to be developed or modified
   32
                 for NPI?


                 Will NPI be a replacement value for the current value in the
   33
                 provider database?


                 Will NPI be an additional value in a provider cross-reference
   34
                 database?



   35            Will NPI Taxonomy need to be included in the provider database?




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                                                                                PROCESS FLOW WORKSHEET


                 Will the division level database be able to accommodate the fixed
   36
                 length NPI and the alpha-numeric Taxonomy values?


                 What should be the data structure of this division level provider
   37
                 database?



   38            What should be the access method to this NPI data?


                 Will access to this division level provider data be a new interface
   39            and, if so, will this access need to be communicated and
                 authorized?

   40          Department Level



   41            Is there a need to access a DHHS NPI repository if developed?



   42            How would a DHHS NPI repository be used?



                 What should be the data structure of this department level provider
   43
                 database?



   44            What should be the access method to this NPI data?



   45          Local/System Level


                 Will a local/system provider database need to be developed or
   46
                 modified for NPI?


                 Will NPI be a replacement value for the current value in the
   47
                 provider database?




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                                                                                 PROCESS FLOW WORKSHEET


                 Will NPI be an additional value in a provider cross-reference
   48
                 database?



   49            Will NPI Taxonomy need to be included in the provider database?



                 Will the local/system level database be able to accommodate the
   50
                 fixed length NPI and the alpha-numeric Taxonomy values?


                 What should be the data structure of this local/system level
   51
                 provider database?



   52            What should be the access method to this NPI data?



   53



   54      Excel Spreadsheet



   55            Will a spreadsheet need to be developed or modified for NPI?



                 Will NPI be a replacement value for the current value in the
   56
                 provider spreadsheet?


                 Will NPI be an additional value in a provider cross-reference
   57
                 spreadsheet?


                 Will NPI Taxonomy need to be included in the provider
   58
                 spreadsheet?


                 Will this NPI provider spreadsheet need to interface with other
   59
                 provider repositories?



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                                                                               PROCESS FLOW WORKSHEET



   60



   61        External Database

                 Will an external provider database need to be developed or
   62            modified for NPI/Taxonomy? (e.g., another division, another
                 system, etc.)

                 Will access to this external provider data be a new interface and, if
   63
                 so, will this access need to be communicated and authorized?



   64


   65   Provider Information is used:

   66       Screens



   67            Will NPI/Taxonomy need to appear on any output screens?



   68            Does the screen currently utilize a hard-coded provider identifier?



   69            Will screen data need to combine pre-NPI data and NPI data?



   70



   71        Reports



   72            Will NPI/Taxonomy need to appear on any output documents?




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                                                                                    PROCESS FLOW WORKSHEET



   73            Does the report currently utilize a hard-coded provider identifier?



   74            Will document data need to combine pre-NPI and NPI data?



   75



   76       Processes



   77            Will NPI/Taxonomy need to be used in any IT processes?



                 Are these processes supported by an outside vendor and has any
   78
                 NPI communication occurred?



   79            Do the processes currently utilize a hard-coded provider identifier?



                 Will NPI/Taxonomy need to be used in any Non-IT processes?
   80
                 (e.g., licensing, credentialing, privileging, certifying, hiring, etc.)



   81



   82      Data Files



   83            Will NPI/Taxonomy need to be present on any output files?



   84




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                                                                              PROCESS FLOW WORKSHEET


   85       Data Store Interfaces


                 Will NPI/Taxonomy need to be transferred to any secondary data
   86
                 stores?



   87


   88   Provider Information process usage:

   89        Claims Payment Purposes


                 Will Taxonomy be required on any claims, either paper or
   90
                 electronic?



   91            Will NPI/Taxonomy be needed in editing logic?



                 Will NPI/Taxonomy be needed in auditing logic? (e.g., combination
   92
                 of pre-NPI claims and NPI claims)



   93            Will NPI/Taxonomy be needed in prior approval logic?



   94            Will NPI/Taxonomy be needed in rate identification logic?



   95            Will NPI/Taxonomy be needed in budget identification logic?



   96            Will NPI/Taxonomy be needed in client eligibility logic?



   97            Will NPI/Taxonomy be needed in provider eligibility logic?



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                                                                               PROCESS FLOW WORKSHEET


                 Will pending pre-NPI claims need to be handled during the
   98
                 conversion period?



   99



  100      Billing Purposes


                 Will the process need to generate bills, either paper or electronic,
  101
                 to Medicaid?


                 Will the process need to generate bills, either paper or electronic,
  102
                 to Medicare?


                 Will the process need to generate bills, either paper or electronic,
  103
                 to 3rd Party Health Plans?

                 Will the process need to generate bills, either paper or electronic,
  104            to other sources using NPI? (e.g., government-funded programs
                 not considered health plans)

                 Will the process need to generate claims with dual provider
  105
                 identification to any payer(s)?



  106            Will Taxonomy need to be mapped to any claims?



                 Will the process need to recognize legacy provider identification for
  107
                 billing/re-billing/coordination of benefits/reconciliation purposes?



  108



  109       Reporting Purposes




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                                                                           PROCESS FLOW WORKSHEET



  110            Will NPI/Taxonomy need to be used in report generation?



  111            Will NPI/Taxonomy need to be used in output file generation?



  112



  113      Informational Purposes


                 Will NPI/Taxonomy need to be stored for informational purposes
  114
                 only?



  115



  116       Security Purposes



  117            Will NPI/Taxonomy be needed to authorize online access?



  118            Will NPI/Taxonomy be needed to authorize report access?



  119


  120   Process Interfaces:

  121        Screens



  122            Will this process need to display NPI data online?




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                                                                             PROCESS FLOW WORKSHEET



  123            Will screens need to combine pre-NPI data and NPI data?



  124



  125      Reports


                 Will this process need to generate hard-copy reports displaying
  126
                 NPI?


                 Will this process need to generate soft-copy reports displaying
  127
                 NPI?


                 Will NPI data need to appear on any other output documents?
  128
                 (e.g., authorizations, letters, financial forms, etc.)



  129            Will reports need to combine pre-NPI data and NPI data?



                 Will any documentation need to modified to reflect NPI changes to
  130
                 reports?



  131



  132       Processes


                 Will this process need to call other processes using NPI/Taxonomy
  133
                 data?


                 Will communication need to be made with these further processes
  134
                 concerning NPI/Taxonomy changes? (e.g., file formats, etc.)




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                                                                              PROCESS FLOW WORKSHEET



  135



  136        Data Files


                 Will this process need to generate output files containing
  137
                 NPI/Taxonomy?


                 Will communication need to be made with the recipient of these
  138
                 files concerning NPI/Taxonomy changes? (e.g., file formats, etc.)



  139



  140       Data Stores


                 Will this process need to send data containing NPI/Taxonomy on
  141
                 any data stores?


                 Will communication need to be made with the recipient of this data
  142
                 concerning NPI/Taxonomy changes? (e.g., data formats, etc.)



  143


  144   Non-IT Processes

  145        Forms

                 Will other forms (non-IT) need to be identified for NPI/Taxonomy
  146            modifications? (e.g., prescription pads, employment applications,
                 provider directories, etc.)

                 Will Trading Partner Agreement forms need to be reviewed and
  147
                 updated for NPI/Taxonomy?




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                                                                                PROCESS FLOW WORKSHEET



  148



  149        Personnel


                 Will NPI staff responsibility documents need to be
  150
                 updated/documented? (e.g., work plans, job descriptions, etc.)

                 Will contracts need to be reviewed and updated for
  151            NPI/Taxonomy? (e.g., Business Associate Agreements,
                 contract/temporary staffing, vendor agreements, etc.)


  152



  153        Security


                 Will any security issues need to be reviewed/established for
  154
                 NPI/Taxonomy?



  155            What level of protection will need to be afforded to NPI/Taxonomy?



  156


  157   NPI Documentation/Communications:

  158        Division/Facility Management


                 Will existing or new division/facility policies need to be
  159
                 modified/established for NPI/Taxonomy and communicated?


                 What is the approximate level of effort to remediate the business
  160
                 process areas? (e.g., week/s of work)




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                                                                               PROCESS FLOW WORKSHEET



  161            Will NPI transition schedules need to be established?



                 Will provider enrollment policies/procedures need to be redefined
  162
                 and communicated for NPI/Taxonomy?

                 Will staff provider requirements need to be
                 established/communicated for obtaining/maintaining
  163
                 NPI/Taxonomy? (e.g., existing staff, hiring, exit interviews, annual
                 reviews, etc.)

                 Will Division Business Continuity Plans need to be
  164
                 reviewed/updated to address NPI? (see information tab)



  165



  166        Providers (both Type 1 and Type 2, if applicable)


                 Will providers (both Type 1 and Type 2, if applicable) need to be
  167
                 notified of the need to obtain and/or report NPI/Taxonomy?

                 Will providers (both Type 1 and Type 2, if applicable) need to be
  168            instructed as to how/when to report NPI/Taxonomy? (e.g., NPI
                 only or full re-enrollment?)

                 Will providers (both Type 1 and Type 2, if applicable) need to be
  169            instructed as to how/when to maintain NPI/Taxonomy? (e.g.,
                 taxonomy changes, demographic information, etc.)

                 Will providers (both Type 1 and Type 2, if applicable) need to be
  170
                 informed as to where NPI forms/screens are located?

                 Will NPI transition schedules need to be
  171            established/communicated to providers (both Type 1 and Type 2, if
                 applicable)?

                 Will Business Associate Agreements need to be reviewed/updated
  172
                 for NPI/Taxonomy?


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                                                                                PROCESS FLOW WORKSHEET


                 Will Trading Partner Agreements need to be reviewed/updated for
  173
                 NPI/Taxonomy?



  174



  175        Technical Staff


                 Will NPI/Taxonomy technical requirements need to be
  176
                 developed/communicated to the technical support staff?

                 Will additional technical staff be required for remediation efforts? If
  177            so, what are there specific technical skills needed? (e.g., Web,
                 mainframe, etc.)

                 What is the approximate level of effort to remediate the IT system?
  178
                 (e.g., week/s of work)



  179            Will NPI implementation schedules need to be developed?



                 Will vendor communication need to be established for
  180
                 NPI/Taxonomy modifications?

                 Will NPI/Taxonomy need to be communicated to the technical
  181            support staff in regards to all new development, current and
                 future?

                 Are there known constraints or dependencies (e.g., changing
  182            requirements) that need to be taken into account for the
                 remediation effort?


  183




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Key Definitions

 1) National Provider Identifier (NPI)
   Purpose: Replaces the use of ALL legacy provider identifiers for HIPAA covered health care providers in standard HIPAA
   transactions (e.g., UPIN, Medicaid provider number, Medicare provider number, Blue Cross Blue Shield provider number)


   Characteristics:
    Unique identifier
    Ten (10) character value (9 plus the check digit)
    All numeric
    Does not change over time
    May be deactivated/reactivated
    Non-intelligent (does not convey information about the provider)

   X12N 837 Data Elements
    Billing Provider ID
    Pay-to Provider ID
    Rendering (Attending) Provider ID
    Referring Provider ID
    Supervising Provider ID
    Purchasing Provider ID
    Service Location ID

   2) Taxonomy Code
     Purpose: Conveys information about the provider's Type (e.g., Individual or Organization), Classification (e.g., Psychologist,
     Psychiatric Hospital) and Area of Specialization (e.g., Clinical, Childrens)

     Characteristics:
      An additional, unique, 10 character value
      Alphanumeric
      May occur multiple times for a single NPI


Additional Information

 1) Business Continuity Plans
As with other implemented phases of HIPAA, a continuity plan should be considered.
While it is not anticipated there will be any contingency plan provided by CMS, a
provider should evaluate the impact to the revenue cycle of its business with the
assumed greatest impact in claim submission and reimbursement. When the rule
becomes enforceable law on May 23, 2007, all providers, regardless of type or size
should implement a cash flow evaluation plan.

This plan should include monitors for reimbursement, denials, rejections, and
claim acceptance notices (997 or proprietary reports from plans and clearinghouses).
Providers may wish to evaluate the possibility of establishing a higher cash reserve
in the event of key health plans or an industrywide delay in claim reimbursement.
Potential barriers should be identified and providers should determine their business
plan to address each identified barrier. A potential barrier might be a plan that is
unable to receive or process the NPI on a claim.

A provider’s continuity plan might be to be ready to submit paper claims, or continue to
submit legacy numbers on claims for health plans who place the provider in this
situation. Continuity planning requires careful thought and consideration. Mitigation of
the negative financial impact to the provider with the NPI implementation is as critical as
any other HIPAA-related implementation.
                             NPI transaction concept
         “As Is”                                           “To Be”

     Identification Number
   ·    Social Security
        Number
   ·    Employer                   Primary Field       NPPES issued National
                                                       Provider Identifier (NPI)
        Identification
        Number




                                                         Identification Number
                                                       ·    Social Security
       Health plan issued                                   Number
       Provider Number             Secondary Field     ·    Employer
                                                            Identification
                                                            Number




“Intelligent Code”
Varies by Plan                                       Taxonomy Code
·    Location                                        ·  Type
·    Specialty                                       ·  Categorization
·    Service                                         ·  Specialty
·    Managed Care
·    Contract

								
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