If you have not contacted your vendor about upgrading to the “5010” version of the Health Insurance Portability and Accountability Act (HIPAA) transactions and about implementing HIPAA’s ICD-10 codes, you need to do so soon.
Physician practices that want to continue sending and receiving electronic HIPAA transactions - check patient eligiblity, file a claim or receive remittance advice - MUST UPGRADE to the 5010 version by Jan. 1, 2012, and begin using the ICD-10 codes by Oct. 1, 2013.
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 transaction was completed in 2000. 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 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?
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.
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.
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. The upgrade to 5010 needs to be completed before ICD-10 codes can be reported.
Contacting your vendor soon is a must because you need to find out what upgrades need to be made to your practice management system, when the upgrades can be completed, and any changes to your system that will be required to accommodate the ICD-10 codes. Remember that your vendor likely has dozens or more other customers.