5010 Implementation Compliance by July 1, 2012 or ???
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 made sweeping changes to the medical records world and businesses indirectly tied to that world, like software vendors and medical collections companies. The act was understood to be good for patients’ privacy and good for the medical industry in terms of having one set standard for electronic patient records. However, HIPAA introduced many rules medical providers and their related business partners had to understand and implement correctly to avoid fines.
HIPAA is creating another ripple in the medical world this year, as an updated standard, version 5010, will be required shortly. Version 5010 will affect anyone who electronically submits administrative transactions, such as checking a patient’s eligibility, filing a claim, or receiving a remittance advice, either directly to a health insurance payer or through a clearinghouse.
5010 has data reporting requirements that will help reduce ambiguity and eliminate redundant and unnecessary data. Medical offices may be required to collect additional data or report data in a different format. For instance, physical addresses are required for billing providers; PO Boxes and lock boxes may no longer be used. Hyphens may no longer be used in social security or employee identification numbers and these numbers may no longer be used as primary identifiers. 5010 will require a 9-digit zip code for billing providers and service facility locations. In addition, there are more subtle changes, including anesthesia services which now must be reported only in actual minutes, rather than units of time as previously allowed. For a table of 4010 to 5010 reporting changes, visit the American Medical Association.
These are just a few of the changes HIPAA 5010 represents to the medical industry and those who conduct business with the industry. Providers, insurers, and other industry businesses have been scrambling to understand and meet these new regulations and the implementation date (that is, the last date to submit under the old version without penalty or rejection of claims) has already been extended from January 1 to July 1, 2012.
Compliance with 5010 requires coordination with software vendors, billing companies and payers, workflow changes, training of personnel, internal testing and external testing – all while maintaining a busy practice. With July 1, 2012 looming, there’s no time to waste in ensuring all systems are ready. Everyone from the ambulance crew to the medical collections agency needs to understand and be ready for HIPAA 5010!
The International Classification of Diseases (ICD) will also be making significant changes effective October, 2013. More info to come on that later.
Post any questions you may have about HIPAA 5010 changes in the post comments field or contact Optio Solutions for more information. For tips on managing patient payments before and after care, download our white paper.