Providers preparing for 5010 Enforcement–Medical Billers and Coders need of the hour


Already halfway through the HIPAA Version 5010 noncompliance grace period and in this scenario it is imperative for doctors who still haven’t to utilize the remaining few days to upgrade to 5010, as non compliance of submitting electronic claims in the appropriate 5010 format post 1st April, 2012, will result in the Centers for Medicare and Medicaid (CMS) penalizing the medical organization. Moreover CMS too is reaching out to remind providers, of the Version 5010 standard to be enforced beginning 1st of April.

Medical practitioners who still haven’t are required to make efforts to upgrade to the new format, post January claims or bills that are not submitted in HIPAA 5010 get rejected, but delay in enforcement currently allows physicians to resubmit in the appropriate HIPAA 5010 format without penalty only till 1st April 2012. Moreover a Survey by the Medical Group Medical Association (MGMA) estimated that upgrading to HIPAA 5010 could set providers back $16,575.

Preparing for 5010 enforcement

According to CMS to ensure a smooth upgrade prior to April, medical organizations need to complete both phase I internal and phase II external testing of Version 5010 transactions. External testing includes tests conducted with outside trading partners – vendors, clearinghouses, billing services, and payers.

However as some doctor practices already implementing the new 5010 format since January are facing severe payment disruptions, hence practices can benefit by preparing for this upcoming effort by developing an implementation plan including:

  • Identifying changes to data reporting requirements
  • Identify potential changes to existing practice work flow and business processes
  • Identify staff training needs
  • Testing with the trading partners, e.g., payers and clearinghouses
  • Budgeting for implementation costs, including expenses for system changes,
  • resource materials, consultants, and training

Medical Billers & Coders – Need of the hour

With certain physician offices currently submitting claims in the 5010 format facing billing issues, Medical Group Management Association (MGMA) President has called for another delay on 5010 enforcement until at least 30th June, 2012, allowing physicians and insurers to do business electronically based on the earlier Version 4010 standards till then. Nonetheless physicians in anticipation of the enforcement need to gear up and in this crucial time physicians short of time can benefit from partnering with experts who can assist them with the transition process and medical billers and coders who can solely concentrate and help in minimizing certain billing and revenue issues arising through this transition. has been servicing the healthcare industry for over a decade now is an apt choice prior and post implementation to HIPAA 5010 to ensure smooth and efficient Revenue Cycle Management. Our Medical billers and coders are updated with all the requisite reforms and trained on ARRA 2009, ICD 9, ICD -10, HIPAA 5010 – practicing handling Revenue Management Cycle for various clients, are highly motivated to provide you with the right course of action to take in the current challenging healthcare industry.

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