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Physicians to make the most of 5010 Enforcement Delay

December 22, 2011

Physicians were mainly relieved with the announcement made by Centers for Medicare & Medicaid Services (CMS) Office of E-health Standards and Services (OESS) on 17th November, to delay enforcement of Health Insurance Portability and Accountability Act HIPAA 5010  transaction standards with a 90-day discretion period for all HIPAA covered entities. CMS stated that their decision is based on industry feedback that a number of organizations and their trading partners would not be able to finalize system upgrades to 5010 standards in time with the initial 1st January, 2012 deadline.

Contrary to what many physicians anticipated, the process of transitioning from Version 4010 to 5010 is much more difficult, hence the delay has been a boon for physician’s practices, if CMS had not taken this step there could have been a possibility of a revenue-cycle train wreck.

Any claims or bills submitted after January 1, 2012, that are not in HIPAA 5010 will still get rejected, but delay in enforcement allows physicians to resubmit in the appropriate HIPAA 5010 format without penalty, hence it is imperative for doctors who have not upgraded to HIPAA 5010 to utilize the next 90 days to upgrade to 5010 standards. Survey by the Medical Group Medical Association (MGMA) estimated that upgrading to HIPAA 5010 could set providers back $16,575, and 45.2% of practices have not yet started the implementation of software upgrades necessary for HIPAA 5010.

Practice’s preparing to implement 5010 standards –

  • Update software to work under the new standards and contact the software vendors, claims clearinghouses and payers to verify that they are operating as per 5010 standards
  • Practices without up-to-date software can take what Hawkins called the “secondary path” of asking their billing clearinghouses if they are translating claims transactions from the 4010 format to the 5010 standard

As the transition to HIPAA 5010 standards is a necessary step before moving to the ICD-10 set of diagnostic codes physicians need to gear up for the changes. In this crucial time of healthcare reforms physicians short of time can benefit from partnering with experts who can handle their entire revenue cycle, in order to concentrate more on streamlining their process and enhance patient care. Even looking out for a software change to HIPAA 5010 compliance Medical Billing software could ease the pressure of physicians trying to migrate to a software solution.

Medicalbillersandcoders.com expert consultancy and software advice services support healthcare providers across the US with their revenue cycle management. MBC also offers professional support and assistance to healthcare providers to keep abreast of the changing industry norms, so that they can concentrate on their core services such as patient care.

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Category : ACA / HIPAA / Reforms