Federal Agency: HIPAA 5010 Electronic Transaction Standards. Upgrade or You Won't Get Paid!


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Topic Federal Agency: HIPAA 5010 Electronic Transaction Standards. Upgrade or You Won't Get Paid!
Background The U.S. Department of Health and Human Services requires all "covered entities" (physicians, clearinghouses, insurers, and others with access to digital personal health care data) to convert to the new 5010 transaction set by Jan. 1, 2012. Established by the Health Insurance Portability and Accountability Act (HIPAA) of 1996, these are the electronic transactions used to transmit patient, physician, and provider data among those covered entities. Despite what you may have heard elsewhere, CMS will not delay the deadline.
Regulating Body Centers for Medicare and Medicaid Services (CMS)
Compliance Date 1/1/2012
Consequences This Doomsday headline will come true if you do not upgrade your electronic billing systems to comply with the HIPAA 5010 electronic claims standards. If you don’t do so by Jan. 1,2012, Medicare, Medicaid, and the commercial insurance carriers will not pay your claims. The government has said that it will hold off on imposing penalties, but still require compliance.
Next Steps 1) Contact vendors to see if a 5010 upgrade is required for your practice management or electronic health record systems. 2) Check the 5010 Update pages for your clearinghouse, billing service and payers to see when they will be ready for testing. 3) Identify changes to data reporting requirements and modify your business procedures to capture that data. 4) When upgrades are complete, send test claims to each of your payers. 5) Budget for unanticipated cash flow interruptions.
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