in HIPAA Headlines by John Brewer

There is a “Time Bomb” ticking in the healthcare industry that is more important that the crazy healthcare debates that is taking place in Congress.

This revolves around the ability to get medical billing to the insurer for reimbursement and receiving successful payment. This is the process that if not done properly in January 2011, will result in “Zero” payment for some healthcare organizations.

So what is this ticking “Time Bomb”? It is the format for the HIPAA billing transactions that define what data and in what form is authorized to be sent from a medical facility to a healthcare insurer.

In short it is the electronic transaction that is mandated by HIPAA.

This format is present in every practice management system, hospital system, claims processing system, financial system, and in some EMR systems in Healthcare. The format is controlled by the vendor of the healthcare information system whether at a practice, a hospital, a payer, or a clearinghouse.

How can the “Time Bomb” be defused? Simple, ask your vendor of the practice management systems, hospital information system, claims processing system when they will be able to confirm that they are “HIPAA 5010 Compliant).

The HIPAA transaction formats currently exist in a 4010 format. These must change to the 5010 format to accommodate the new implementation of the mandated ICD10 codes by 2013. In order to streamline the process, accommodate ICD10 and to create a new HIPAA compliant transaction process the “5010 Format” must be implemented and testing during 2010.

If done properly your practice management, hospital information system, claims processing, clearinghouse software or billing company will be updated in late 2010.  This will accommodate the tested HIPAA 5010 Billing Transactions and your practice will be able to submit bills and receive reimbursement after January 1, 2011.

If not done you will be wondering why you are having rejected bills and not being reimbursed for services rendered.

So ask of all your vendors (including your 3rd party billing company) today where they stand on making their systems HIPAA 5010 compliant and protecting your organization from revenue short falls in 2011. Demand a timeline of their compliance, testing and certification, as well as their schedule of when they will have your systems ready to submit with 5010 billing transactions.

Dr. Bysinger published Investing in Information Technology in 1996 based on models for using technology to create business advantage. He has published numerous articles on eHealth, HIPAA, and Healthcare Technology in healthcare journals including, Healthleaders, Health Data Management, Advance for Healthcare Executives, and others. In addition Bill has given more than 50 presentations at national association conferences including, HIMSS, AHP, AHIMA, NAHQ, MSHUG, NMHCC, HFMA, and CAWorld.
He can be reached at 478-951-2010.
This article originally published in the March 2010 issue of “Vital Signs” Vol. 32 No.3

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