Just Over 90 Days Until January 2011 Testing for Version 5010
As of January 1, 2011, neurology practices should be prepared to begin testing the version 5010 Health Insurance Portability and Accountability Act (HIPAA) transactions with their trading partners, including payers and clearinghouses. External testing with your trading partners is critical for ensuring that you are ready for the January 1, 2012, compliance date for sending and receiving only the version 5010 transactions.
To begin external testing with trading partners, practices need to have completed the following:
- Conducted an impact analysis
- Contacted their vendors and trading partner
- Installed the systems upgrades
- Conducted internal testing of their system
The Centers for Medicare & Medicaid Services' (CMS) Medicare Fee-for-Service program will be ready to test the version 5010 transactions in January 2011. CMS has made it clear that the Jan. 1, 2012, deadline for implementing the version 5010 transactions will not be extended. Missing this deadline puts you at risk for rejected transactions, denied claims and delayed reimbursement.
The AMA offers various resources to help you prepare your practice to implement version 5010 by the January 1, 2012, deadline.
Resources Now Available to Prepare for Implementing the 5010 Standard Transactions
As of January 1, 2012, physicians are mandated to use an updated version of the Health Insurance Portability and Accountability Act (HIPAA) electronic standard transactions, generally known as "5010."
The Academy is pleased to provide a link to the American Medical Association (AMA) series of fact sheets that outline details that physician practices need to know in order to effectively implement the 5010 electronic standard transactions starting on January 1, 2012.
Visit the AMA website to access these three fact sheets:
- HIPAA 101: How It Started and What's Next
- 5010 Timeline: Getting the Work Done in Time for the Deadline
- HIPAA Terminology
HIPAA 5010 Compliance Date Set for January 1, 2012
The Academy would like to notify members that covered entities must comply with the HIPPA Standards—Version 5010 as of January 1, 2012. The new 5010 includes structural, front matter, technical, and data content improvements; and its adoption will reduce ambiguities. Version 5010 also addresses a variety of currently unmet business needs, including, for example, providing on institutional claims an indicator for conditions that were "present on admission." The new version of the standard for electronic health care transactions (Version 5010 of the X12 standard) is essential to the use of ICD-10 codes because the current X12 standard (Version 4010/4010A1), cannot accommodate the use of the greatly expanded ICD-10 code sets.
Background on the 5010 Electronic Transactions Standards
HIPAA requires the Secretary of HHS to adopt standards that covered entities must use in electronically conducting certain health care administrative transactions, such as claims, remittance, eligibility, claims status requests and responses, and others. Covered entities include health plans, health care clearinghouses, and certain health care providers.
What is the National Provider Identifier?
In a regulation published in January 2004, the Department of Heath and Human Services explained that it intends to establish a national provider system (NPS) to administer national provider identifiers (NPI). The NPI will be a 10-digit numeric identifier used in place of other identifiers (e.g., Medicare number, UPIN) for all health care transactions.
All providers that conduct electronic transactions must have an NPI by May 23, 2007. A physician who does not conduct electronic transactions may acquire an NPI but is not required to do so.
What Is HIPAA?
In 1996, Congress changed the way medical practices deal with patients' medical records. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) makes it mandatory to comply with the Privacy and Security Rules.
The passage of HIPAA gave the Federal Government the ability to mandate how health care plans, providers, and clearinghouses store and transmit individuals' personal information as it relates to the administration, provision, and payment of health care.
The Privacy Rule
The Privacy Rule essentially controls the use and disclosure of what is known as protected health information (PHI). Many of its applications are just common sense. Others are more complex, giving patients a great deal of flexibility in the knowledge of what's in their medical record and how that content is used. Patients can now control the disclosure of their protected health information to certain entities. The Privacy Rule deadline was April 14, 2003.
The Security Rule
The Security Rule focuses on the ability of covered entities (including medical practices) to protect and safeguard the confidentiality of medical information. It is similar to The Privacy Rule but more complex in its impact on medical practices in areas specific to the transmission, storage, and receipt of data. Make no mistake, your practice's computer network, who has access to it, and the methods you use to store and handle data will come under close scrutiny. The Security Rule deadline was April 21, 2005.
The Transaction and Code Sets Standards (TCS) deals primarily with electronic transactions. Claims submitted electronically must comply with these regulations. Failure to comply can result in monetary penalties or exclusion from Medicare. The TCS deadline was October 16, 2003.