Come Jan. 1, 2012, all health insurers – Medicare, Medicaid, and private payers – will stop paying claims from any physicians who have not upgraded their electronic billing systems to comply with the HIPAA 5010 electronic claims standards. 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. These are the electronic transactions used to transmit patient, physician, and provider data among those covered entities.
To help you avoid disaster, the Texas Medical Association conducted a Tele-Town Hall Meeting on the new standards on Thursday, Sept. 22. TMA President C. Bruce Malone, MD, moderated the discussion, which featured expert presentations from TMA physician leaders and staff.
Participants on the call learned the details of the conversion, how to prepare to upgrade their practice management or electronic health record (EHR) systems, how to develop an action plan, and the impact on their business functions.
Despite what you may have heard elsewhere, the Centers for Medicare & Medicaid Services (CMS) will not delay the deadline. It will remain Jan. 1.
TMA established the TMA HIPAA 5010 Resource Center on the TMA website to help you make the conversion. It includes background on the issue, questions to ask vendors, contact info for EHR, 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.
Please answer these questions to let TMA know what progress you have made in updating your billing systems to meet the Jan. 1, 2012, deadline. TMA will publish the results and information about 5010-ready vendors in the 5010 Resource Center as it receives information.
The switch from Version 4010/4010A1 to Version 5010 is part of the ICD-10 conversion that takes effect Oct. 1, 2013. TMA plans hands-on workshops and training for physicians and staff in early 2012 to help physicians switch from ICD-9 to ICD-10. Check the TMA website for updates. TMA currently offers variety of training options, including webinars and ICD-10 boot camps.
Action, Sept. 16, 2011