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Practices Get More Time to Switch to HIPAA 5010

Physicians and health plans have a kind of grace period for the first three months of 2012 before they must comply with new HIPAA Version 5010 claims transaction standards.

The Centers for Medicare & Medicaid Services' Office of E-Health Standards and Services (OESS) announced Nov. 17 that it will delay enforcement of the new rules, which govern the format of claims submissions and payments. CMS is calling the delay a “period of enforcement discretion.”

HIPAA 5010 standards—and the Jan. 1, 2012, deadline for meeting them—were announced Jan. 16, 2009. HIPAA 5010 changes the format of electronic claims in an attempt to reduce redundancy and confusion. Medicare and other payers could reject the claims of practices that do not implement the conversion.

According to the office's statement, the decision to temporarily delay enforcement stemmed from ”industry feedback, revealing that with only about 45 days remaining before the Jan. 1, 2012, compliance date, testing between some covered entities and their trading partners has not yet reached a threshold whereby a majority of covered entities would be able to be in compliance by Jan. 1.“

Like CMS, the American Medical Association encouraged physicians to continue working on coming into compliance rather than using the three-month period to put off dealing with the changes they need to make.

The AMA, along with the Healthcare Billing and Management Assn., Healthcare Information and Management Systems Society, Workgroup for Electronic Data Exchange and American Health Information Management Assn., is behind the Get Ready 5010 website featuring resources to help physicians and their staff understand and prepare for the switch.

For many practices, preparing will just mean contacting software vendors, claims clearinghouses and payers to verify that they are operating under 5010 and that the practice's software is updated to work under the new standards, said Matthew Hawkins, chief executive officer at Vitera Healthcare Solutions, an electronic records vendor in Tampa, Fla.

“Depending on the technology vendor, some physician practices will already be compliant,” he said.

Even practices without up-to-date software can take what Hawkins called the “secondary path” of asking their billing clearinghouses if they are “mapping”—or translating—claims transactions from the 4010 format to the 5010 standard.

He said often only minor changes are necessary for physicians beyond verifying that vendors and payers are up to speed. Among those: The service location listed on a claim must have a nine-digit ZIP code and be a physical address, not a post office box.

Hawkins said making those changes should involve “minimal work.”

The transition to HIPAA 5010 standards is a necessary step before moving to the ICD-10 set of diagnostic codes, said Kristine Weinberger, senior health care business consultant at Edifecs, a software and consulting firm in Bellevue, Wash.

The AMA has called for a delay of the October 2013 ICD-10 deadline.




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