Medical Billing- What Medical Practices Can Do To Meet 5010 Standards

Medical Billing- What Medical Practices Can Do To Meet 5010 Standards

As a part of HIPAA (Health Insurance Portability and Accountability Act), the 4010A1 version of electronic transaction standards will be replaced by 5010. The 5010 transactions are designed to enhance the electronic exchange of information related to the following:

Electronic remittance advice

Treatment authorization

Insurance inquiry and verification

Electronic claim submission

Claim status inquiries

In short, these standards address all of the electronic exchanges of administrative and financial information between health plan administrators, healthcare providers, vendorsand patient care services clearinghouses.

January 1, 2012 has been set as the compliance date for the 5010 standards by the Center for Medicare and Medicaid Services (CMS). In fact, any 4010/4010A1 transactions sent on or after 1-1-2012, will be rejected and not processed.

How to Meet the Standards

The conversion to 5010 will be dependent on when your vendor has assimilated the upgrades into the system. That's where you have to begin your preparations to be compliant by 1-1-2012:

Speak with your software or practice management vendor. Find out from them when the software updates will be available for your system and when you can expect to see them installed.

Budget for the implementation costs. This includes system change, training, resource material and consultant expenses.

Determine when your payers, billing service, clearinghouses and health care plan administrators will have the upgrades installed so you can begin testing with them.

Review your process practices to identify any workflow changes that will be necessary to accommodate 5010. For example, you might need to collect or report data differently than you currently do.

Identify any staff training needs and complete the training.

Test internally to ensure you can generate clean 5010 transactions to the appropriate places.

Test with your external partners to ensure you can send and receive the 5010 transactions.

When to Implement

You do not have to wait until 1-1-2012 to begin using the new standards. In fact, if you are prepared prior to then, check with your vendors to try and mutually agree to begin using them ahead of time. This will give you the ability to see that the transactions are being processed smoothly. If you do find any issues, you can address them prior to the compliance date.

No matter what though, you will have to begin using 5010 on 1-1-2012. At this time, it does not appear that date will be delayed.

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