5010: What is it?
5010 is the new HIPAA standard that regulates electronic transactions. HIPAA 5010 transactions will affect almost every aspect of a practice’s reimbursement and revenue stream including eligibility, submitting electronic claims, and ERA’s. In order to achieve compliance, physicians will need to update their practice management system and adjust for changes in workflow. It may seem daunting, but the effort will pay off in improved business processes and a shorter revenue cycle.
Will it affect me?
If you submit any claims electronically, then the switch to 5010 will affect you.
All of the entities listed below are required to upgrade to HIPAA 5010 standards;
• Physicians • Hospitals • Payers • Clearinghouses • Pharmacies • Dentists
Additionally, even though practice management vendors are not included in this list, they will need to upgrade their products to support HIPAA 5010. The following are the specific transactions affected:
• 270/271 – Health Care Eligibility Benefit Inquiry and Response
• 276/277 – Health Care Claim Status Request and Response
• 278 – Health Care Services – Request for Review and Response; Health Care Services Notification and Acknowledgment
• 820 – Payroll Deducted and Other Group Premium Payment for Insurance Products
• 834 – Benefit Enrollment and Maintenance
• 835 – Health Care Claim Payment/Advice
• 837 – Health Care Claim (Professional , Institutional, and Dental), including coordination of benefits (COB) and subrogation claims • NCPDP D.0– Pharmacy Claim
What is the timeline?
Jan 2009
Begin Level 1 activities (gap analysis, design, and development)
Jan 2010
Begin internal testing for HIPAA 5010
Dec 2010
Achieve Level 1 compliance (covered entities have completed internal testing and can send and receive compliant transactions)
Jan 2011
Begin Level 2 testing period activities (external testing with trading partners and move into production; dual 4010A/5010 processing mode) Begin initial ICD-10 compliance activities (gap analysis, design, development, and internal testing)
Jan 1, 2012
5010 compliance date for all covered entities
Oct 1, 2013
The compliance date for ICD-10-CM and ICD-10-PCS
What happens if I don’t do it?
After January 1, 2012, Medicare, Medicaid, and commercial insurers won’t accept claims that aren’t compliant…you won’t get paid!
Additional Links
5010
AMA’s interpretation
AMA’s guidelines on HIPAA
Implications and Opportunities
ICD-10
CMS overview
How can DataPulse help me?
DataPulse CS is a full-feature . Net Practice Management System that will help you transition quickly and easily to the new 5010 standards. Make sure your revenue stream isn’t affected by contacting DataPulse today.
|
