Are You Ready for HIPAA Version 5010?
If your practice electronically submits administrative transactions, to verifying a patient's insurance eligibility, file claims, send or receive a remittance directly to an insurance company or through a clearing house – the transaction version for that system will have to be updated by January 1, 2012.
The Department of Health and Human Services announced that the 2009 Final Rule implemented the regulatory rule to update the transaction version to 5010 – this is mandatory as, the Health Insurance Portability and Accountability Act transactions will be required for use by all physicians and other health care providers. The current version 4010 is now outdated and cannot provide accommodation of the necessary business transactions for physician practices and health care facilities.
The Timeline:
January 1, 2012
All transactions can only use Version 5010 for transactions – 4010 transactions will be non-compliant and all communication or claims will be rejected.
After January 1, 2012
All 5010 submissions and receipts will need to be monitored for the first three to four months to ensure the system is working properly.
October 1, 2013
All diagnosis coding will change from ICD-9 to ICD-10. Learn more.
Rheumatology practices should begin now to meet the implementation deadline- below is a few necessary steps for physicians to prepare for 5010:
- Meet and discuss implementation with your practice management vendor if their product will be upgraded to meet the requirements of 5010.
- Meet and discuss with clearinghouse and confirm that the system will sustain the change to 5010.
- Confirm with both practice management vendor, clearinghouse and payers when they will begin testing for 5010
- Verify with your clearinghouse if there will be any additional cost to you for the system change over or for staff training
- Discuss with your PM vendor and clearinghouse if the systems will be able to support the current HIPAA version 4010 and 5010 during the transition phase
- Create a team or assign key staff to work with vendors on practice work flow and other daily transactions.
- Generate a budget for expenses related to training, system changes and any other necessary resources that your practice will need for implementation.
Implementation of version 5010 is not optional, and rheumatology practices should begin early testing and implementation prior to January 1, 2012 to avoid any disruption in patient flow and reimbursements.
For additional information, visit the ACR website at www.rheumatology.org or contact Antanya Chung, CPC, CPC-I, CRHC, CCP at or (404) 633-3777 ext 818
