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 

The HIPAA Audits Program Objectives

With the Department of Health and Human Services Office for Civil Rights or OCR starting its pilot phase of the HIPAA Privacy and Security Audit Program, an audit will begin for 150 covered entities. There is a speculation as to whether the business associates of the covered entities will be audited as well. The OCR will audit the applied protocols and evaluate any weaknesses in the program besides promoting the best practices. This progression will help the OCR as a guide to collect information on how to conduct and direct HIPAA compliance audits for business associates and covered entities for the future.

Whether there are egregious or unintentional deficiencies, enforcement laws will be applied according to the various levels of non-compliance to the HIPAA Privacy and Security Audit Program. The overview displays that the American Recovery and Reinvestment Act of 2009, in Section 13411 of the HITECH Act has directed the HHS to conduct periodic audits to guarantee that business associates and covered entities to comply with the HIPAA Privacy and Security Rules and Breach Notification standards. With the specified mandate in the progression and implementation stage, the OCR will begin in November 2011 and would be completed by December 2012.

The program objectives will be one of the facets of the OCR’s security, privacy and health information program. The OCR will utilize the audit program to determine the efforts made to comply with the protocols required by HIPAA. The final audit process will exhibit the best practices which will be shared the OCR and serve as a guide to identify challenges of the compliance rules faced by the covered entities and their business associates. The security and privacy audit process will comply with the known audit rules and the OCR will inform the chosen entities for the auditing process to submit audit reports as well as being available for on-site visits. Interviews will take place during site visits with the main personnel concerned with observation and examination of the processes for compliance. The audit reports will display the process of conducting the audit, the findings and the response of the covered entity to any actions on the findings. The final report will hold solutions of revised actions to the rules of compliance and the covered entity will be given opportunities to discuss concerns and identification of any deficits so that they can implement the best practices. 

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

HIPAA Enforcement and Privacy Rules

Enforcement of the Privacy Rule began in April 14, 2003, for many of the HIPAA covered entities with the HHS Office for Civil Rights who were authorized to enforce the Privacy and Security Rules. The covered entities’ privacy practices enforced by the activities of the OCR were leveraged and experienced improved results. The protection and privacy of health information of individuals were systematized with the corrective rules of the OCR that were exercised by covered entities and this resulted in improvement and HIPAA enforcement. With the requirement of complying with the HIPAA Security Rule that was established on April 20, 2005, the OCR was chosen as the authorized agent for the enforcement of the Security Rule on July 27, 2009. 

The covered entities range over healthcare providers such as dentists, clinics, nursing homes, psychologists, nursing homes, chiropractors, pharmacies transmitting information and transacting through an electronic format designed by HHS standards. The Health Plan is rendered through services by HMOs, health insurance companies, healthcare paid by government programs evolving over Medicaid, Medicare, veterans’ health care programs and the military. It is important to note that the processing of health information by healthcare clearing entities are received from yet another entity following a stipulated electronic format.

The HIPAA Rule ranges over the Privacy Rule or the Standards for Privacy of Individually Identifiable Health Information. In order to implement the HIPAA standards or the Health

Insurance Portability and Accountability Act of 1996, the U.S. Department of Health and Human Services or the HHS has enforced the Privacy Rule. This Privacy Rule stipulated that the usage of health information that pertains to the disclosure and use of an individual’s health insurance which is otherwise known as protected health information and the control of violations should be exercised. Coming under the umbrella of the HHS, the Office for Civil Rights or the OCR should be responsible for enforcing, implementing and upholding the Privacy Rule which when violated would call for civil money penalties. With flexibility being one of the aspects of the Privacy Rule, the enforcement has a balanced outlook to the various kinds of uses and disclosures. With the Administrative Simplification provisions addressing the security, privacy and standards for the electronic exchange of health information administered by the Secretary of HHS Sections 261 through 264 of HIPAA or the Health Insurance Portability and Accountability Act of 1996, the Public Law 104-191 was enacted on August 21, 1996.

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