Be Prepared for New 5010 HIPAA Transactions July 5, 2011 EHR, HIPAA, Practice Management, Technology 5010, CMS, HIPAA, practice management 1 The deadline for transitioning electronic transactions to the updated 5010 version of the Health Insurance Portability and Accountability Act (HIPAA) transactions standards is January 1, 2012. Physicians will be required to conduct electronic transactions such as claims submissions, eligibility verification, claims status, remittance advice, and referral authorizations using the updated transaction standards. If physicians’ practice management systems are not up to new standards, they will risk not receiving electronic payments from private insurers and Medicare. The new HIPAA 5010 regulations impact all health care providers who: Send or receive electronic administrative transactions directly to payers—both private and public; and, Send electronic data to a billing service or clearinghouse that submits transactions on your practice’s behalf. What is 5010? The new data standards come out of the Health Insurance and Accountability Act of 1996. It demands for more specificity in what data must be entered and transmitted, with the hope that the claims process will be more efficient and more details will be available about the patient visit. For example, physicians must submit a nine-digit, rather than a five-digit, ZIP code on all claims submissions and submit a street address rather than a post office box. 5010 also allows physicians to distinguish between principal diagnosis, admitting diagnosis, external cause of injury, and patient reason for visit codes. Guidelines for Claims Submission Using HIPAA 5010 Standards Step 1: Impact analysis – Conduct an internal analysis to determine the impact the change to 5010 will have on your practice. Step 2: Vendor, payer, billing service, and clearinghouse connections – Contact your practice management and electronic medical record vendor for details on the installation of upgrades to your system. Contact your clearinghouses, billing service, and payers to find out when upgrades will be completed and when they can accept 5010 transactions. Step 3: Installation of vendor upgrades Step 4: Internal testing and staff training – Once the upgrades are completed, conduct internal testing of your systems to ensure you can generate the 5010 transactions. You will need to train staff during the process of implementing and testing your system. Step 5: External testing with clearinghouses, billing service, and payers Step 6: Making the switch to 5010 – After you have completed external testing with some or all of your trading partners, you may switch to using only the 5010 transactions. You are permitted to begin using the 5010 transaction before the compliance date as long as you and the other organizations agree to the early switch. Step 7: Backup plans – In case transaction is rejected after the switch, make a plan for an interruption in cash flow. Some suggestions: Submit as many transactions as possible before January 1, 2012; decrease expenses before January 1, 2012, to increase cash reserves; establish a line of credit with a financial institution. Source: “5010 Implementation Steps: Getting the Work Done in Time for the Deadline,” AMA. Where Can I Find More Information? GetReady5010.org www.cms.gov/Versions5010andD0/ HIPAA 5010 Guide Comments are closed.
