5010 Compliance Two Weeks Away

Physicians must begin using the new HIPAA 5010 transaction standards on Jan. 1 to submit claims or run the risk of private insurers, Medicare, and Medicaid refusing to pay them. The Centers for Medicare & Medicaid Services (CMS) announced in November that is delaying enforcement for physicians until March 31, 2012, but physicians still must begin using the new HIPAA 5010 format on Jan. 1.

Practices that have upgraded their claims software for 5010 compliance must test it to make sure the claims are in the 5010 format. You should perform this test with any entity that receives your claims directly. For example, if you submit all your claims through a clearinghouse, then you should conduct the test with the clearinghouse. TMA has heard from practices that had problems with their clearinghouse during testing. Be sure to closely monitor all claims and payments during this transition and quickly report to payers anything abnormal, as delay will potentially cost your practice thousands of dollars. 

The TMA 5010 Resource Center includes background information on the issue; questions to ask vendors; contact information for electronic health record, practice management, and clearinghouse vendors; information on how you can finance upgrades to your existing system or purchase a new systems; and an action plan. 

TMA's Payment Advocacy Department reminds physicians that they can check the TrailBlazer Health Enterprises  and the Texas Medicaid & Healthcare Partnership websites to verify that their vendor is approved for Medicare and Medicaid 5010 claims. Contact your vendor as soon as possible if it is not on the list. TMA suggests contacting commercial carriers directly. 

If you are purchasing a new system, it may be a good time to evaluate a companion practice management/electronic health record (EHR) system. This allows eligible physicians to participate in the Medicare or Medicaid EHR incentive programs that pay physicians for meaningfully using an EHR. If you choose to participate, the Texas regional extension centers (RECs) can help you with selection, implementation, and meaningful use.

The REC technical consultants visit your practice and provide $5,000 worth of consulting for a fee of only $300 for primary care physicians.

More information about the REC program is available on the TMA website  

For questions about HIPAA 5010, EHRs, or RECs, contact TMA's Department of Health Information Technology at (800) 880-5720 or via email. 

Keep track of the HIPAA 5010 deadlines and other looming compliance dates with TMA's Calendar of Doom.


Action, Dec. 16, 2011


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