Doctors’ Time Running Out To Meet HIPAA 5010 Requirements

Effective January 1, 2012 there will be a new HIPAA 5010 version that will be a required for doctors to use for electronic filing.  If physicians don’t use version 5010 for all HIPAA electronic transactions by that date, their claims will be rejected and they won’t be paid.  Doctors are feeling the pressure to get their systems ready for this change.  Many physican practices have not embraced the electronic age as well as other businesses have and are now behind the eight ball, scrambling to meet these new standards.  

Medcost.com reported, “The purpose of 5010 is to facilitate the country’s ongoing goal of transitioning to an electronic health care environment by updating the current standards for electronic health care and pharmacy transactions. The updated 5010 versions replace the current versions of the standards and will promote greater use of electronic transactions. This change has been driven by the United States Department of Health and Human Services (HHS).”

There are some helpful resources to show doctors how to prepare for this transition.  GetReady5010 offers free webinars.  The AMA also has some excellent resources. Despite all of these free offerings, many physicians are not prepared for this change. American Med News reported, “Many physicians have not even begun to see if they are compliant with what are known as HIPAA Version 5010 standards. According to a survey released in March by the Medical Group Management Assn., 56% of practices have not scheduled any internal testing for 5010, and 61% have not scheduled any testing with their major health plans. The survey covered 349 practices with 13,290 doctors.”

What’s new in the HIPAA 5010 version? Some of the changes include: 

  • Physicians must submit a nine-digit, rather than a five-digit, ZIP code
  • Physicians may distinguish between principal diagnosis, admitting diagnosis, external cause of injury and patient reason for visit codes
  • 5010 set will allow for the inclusion of ICD-10 codes

Nextgen.com listed the following frequently asked questions relate to HIPAA 5010 to help understand requirements.  Click on the links for answers to each of the questions. 

  1. What is HIPAA 5010?
  2. Who will need to upgrade to HIPAA 5010?
  3. Why must I upgrade to HIPAA 5010?
  4. How is HIPAA 5010 different from HIPAA 4010?
  5. What are the key dates for HIPAA 5010 and what is the deadline for HIPAA 5010 implementation?
  6. What happens if I’m not ready by the compliance deadline?
  7. Is there a chance for a delay in the compliance date?
  8. What do I need to do to prepare for the upgrade to 5010?
  9. If I finish all of this work before the compliance deadline, can I start to use the 5010 transactions?
  10. What provider transactions are implemented with HIPAA 5010?
  11. Where can you obtain the X12 Technical Reports?
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