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Answers, resources can help you with 5010 HIPAA upgrade
e-Reports, September 7, 2010
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If you do any business electronically – check patient eligibility, file a claim or receive remittance advice – your practice should be taking steps now to prepare for the conversion to 5010 transaction standards under the Health Insurance Portability and Accountability Act (HIPAA). But as always, the ISMA and AMA have answers to your questions and helpful resources.

First, take note of the deadline for compliance: Jan. 1, 2012. Remember when 2010 seemed far away? Time passes quickly, and no one anticipates an extension of this deadline, because the targeted conversion to ICD-10 depends on the 5010 upgrade. So, if you haven’t given this issue your attention, today is a good day to get started.

Answers to common questions appear here; see more information from the ISMA and refer to the Medicare section of the July 16 Medicare/Medicaid Coalition Report.

Also, see the AMA website (for members and non-members) and the Centers for Medicare & Medicaid Services website.

Why is the current transaction being replaced?
The new version contains several updates that will improve the connectivity between systems and better support health information exchanges. Version 4010 of the transactions was completed in 2000. Some changes, Version 4010A1, were made in 2002. Since then, many technical issues were found in the transactions and new business needs identified that could not be accommodated. Version 5010 will correct them.

Do I have to upgrade to 5010?
Yes. Physicians are HIPAA “covered entities,” meaning they must comply with the HIPAA requirements when conducting transactions electronically. If you currently send and receive HIPAA transactions and plan to continue doing so, you must upgrade to 5010.

Who else must upgrade to 5010?
Health care clearinghouses and payers are also HIPAA covered entities and will need to upgrade to 5010.

What do I need to do now to prepare for 5010?
You need to take several steps.

  • Talk to your practice management or software vendor. Determine when they will have software updates available and installed in your system. Your conversion to 5010 will be heavily dependent on when your vendor is ready.
  • Talk to your clearinghouses, billing service and payers. Determine when they will have their upgrades completed and when you can begin testing with them.
  • Identify workflow modifications you need to make for 5010 changes. You may need to collect new data or report data differently than you do currently.
  • Identify staff training needs and complete.
  • Conduct internal testing to make sure you can generate transactions in 5010.
  • Conduct external testing with your clearinghouses and payers to make sure you can send and receive 5010 transactions.
Steps to ICD-10

If I finish this work before January 2012, can I start to use 5010?
Yes. You can begin to use the 5010 transactions with your clearinghouses or payers whenever you mutually agree.

How does upgrading to 5010 relate to ICD-10?
ICD-10 is the upgraded version of ICD-9. ICD-10 codes have a different format and length than ICD-9 codes and cannot be reported in the current version of the HIPAA transactions. So, the upgrade to 5010 needs to be completed before ICD-10 codes can be reported.

Read future ISMA Reports for more on ICD 10.

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