Tips for Meeting the Deadline for Version 5010

With the impending deadline for physicians’ medical practices to adopt the Version 5010 HIPAA standards that replaces the 4010 standards, there are many reasons for the delays related to the conversion. As January 1, 2012 is the required date for the adoption of the 5010 standard, the necessary changes for this important procedure are associated with major billing processes such as transaction acknowledgement, eligibility inquiry, claim status inquiry, claims submission and remission. Though the CMS launched the Enforcement Deadline Extension of March 31, it will not be a substitute for the January 1, 5010 deadline.

As the Enforcement Deadline Extension varies from the Compliance Deadline, it means that the government will not inquire with those parties that do not act in accordance with the Version 5010 until a complaint is registered. There is speculation that Medicare and payors will not accept claims that are submitted after January 1 and it is time for practices to start preparing for the 5010 deadline.  The background of the 5010 version stems from the Health Insurance Portability and Accountability Act (HIPAA) enacted by the Congress 15 years back in 1996.  This Act in turn created the HIPAA Privacy Standard, the HIPAA Security Standard and innumerable Notice of Privacy Practices forms. One of the aspects of the HIPAA requirement stated that the Department of Health & Human Services should establish norms for all covered entities. These norms are related to clearinghouses, health plans, medical practices and other associated entities for use in electronically transmitted core administrative transactions.

The existing standard is called 4010 or X12 Version 4010/4010A1. Version 5010 allows for expansion of efficiency for claims transaction and accommodation of ICD-10 codes to be launched in October 2013. Version 5010 leverages a practice's electronic claims transactions but does not affect a practice's clinical operation. Some of the practices are exempted from adhering to the 5010 conversion such as practices with less than 10 employees working full-time are not expected to comply with the administrative simplification provisions of HIPAA. The practice management software electronic clearinghouse or the vendor should be contacted for the necessary advice, submission of a full nine-digit Zip Code when reporting for the service facility and billing provider, P.O. boxes and lock box addresses and a physical address for the billing provider.

For more information, visit http://www.usmedicaltranscriptionservice.com/ or call 1-800-723-4308