Physicians Strive to Strike a Balance between Managing HIPAA 5010 and Medical Billing

The financial and data-centric nature of the healthcare reforms in the US has left healthcare organizations in all the states of the US to do more data care than healthcare – to manage their finances, maintain data integrity and be complaint with regulatory standards. Health Insurance Portability and Accountability Act (HIPAA) is an example, which, however well-meaning otherwise, burdens the healthcare provider with a series of compliance activities, involving technical intricacies, which, if not followed to the letter, lead to claim denials and expose the care provider to a post-denial support system that’s lumbering and unresponsive.

HIPAA, framed to promote convenience and continuity of health insurance coverage for individuals or groups either changing jobs or unemployed through safe data handling and transfer, seeks to establish a standardized method to electronically transfer data by healthcare providers to Medicare contractors to submit insurance claims and be reimbursed.  However, when healthcare organizations are submitting claims through HIPAA’s electronic conduit, HIPAA 5010, they are facing claim rejections due to a number of teething problems HIPAA 5010 is going through currently.

The problems are mostly of administrative and technical in nature, like issues with billing secondary payers, national provider identifiers not being recognized, the care providers are facing while submitting their medical bills to Medicare contractors via HIPAA 5010. The billing process is not just leading to futile administrative works for care providers but also financial losses with Medicare contractors rejecting claims for such minor omissions and errors as claims not having descriptions on them, error in addresses etc. Rejected claims submitted again are meeting with sporadic reimbursements and attempts to contact contractors are resulting in one to two hours of call-hold period.

However, in response to this chaotic situation, The Centers for Medicare & Medicaid Services (CMS), the agency overseeing the transition from HIPAA 4010 to HIPAA 5010, has delayed the enforcement of HIPAA 5010 But will a delayed enforcement of HIPAA 5010, even if it leads to some order and stability, be an answer to healthcare providers’ woes? No. Even in a sanitized atmosphere, healthcare providers would need to handle what they are not meant to, financial administrative activities and compliance matters. This leaves healthcare providers in a ‘rock and a hard place’ situation: avoiding the reform-induced responsibilities would mean falling foul of regulations and attracting penalties; attending to them would lead to increased cost, unrealized claims and time spent on non-healthcare activities.

To survive the onslaught of reforms and changing industry trends, healthcare organizations would require a robust Revenue Cycle Management (RCM) process, a look at the challenges posed by HIPAA 5010, discussed above, indicates that a complete outsourcing model which would enable healthcare providers to offload the complete cycle of financial administrative activities to a biller and coder may not be an imprudent choice. provides RCM consulting services help build a coherent RCM process by analyzing the areas of deficiencies in your RCM process, starting from trimming out outdated processes, identifying software inadequacies, under-optimized workforce to unidentified training needs and most importantly plugging revenue leakage sources resulting in a sound RCM process which helps healthcare organizations meet the current financial and administrative challenges better., the largest consortium of billers and coders in the US, has helped medical practices improve their finances by its outsourced billing and coding services which involves development of accurate electronic billing, intricate procedure coding, electronic filling of claims and a multi-layered application process – collectively resulting in reduced claim denials an enhanced core-business focus.

For more information visit: Medical Billing companies