If your practice electronically submits administrative transactions to verify patient insurance eligibility, file claims, or send or receive remittance either directly to insurance companies or through a clearinghouse, the transaction version for that system will have to be updated by January 1, 2012. The current version 4010 is outdated and cannot accommodate the necessary business transactions for physician practices and healthcare facilities.
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Explore This IssueFebruary 2011
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In the 2009 Final Rule, the Department of Health and Human Services announced the implementation of a regulatory law to update the electronic transaction version form 4010 to 5010. Compliance to the Health Insurance Portability and Accountability Act (HIPAA) ruling is mandatory for all physicians and health professionals by January 1, 2012. You should begin upgrading now in order to meet the implementation deadline. Below are a few steps necessary for physicians to update to 5010:
Implementation of version 5010 is not optional, and rheumatology practices should begin early testing and implementation well before January 1, 2012 to avoid disruption in patient flow and reimbursements.
- Meet and discuss implementation with your practice management vendor if their product will be upgraded to meet the requirements of 5010.
- Meet with your clearinghouse to confirm that its system will sustain the change to 5010.
- Confirm with your practice management vendor, clearinghouse, and payors when they will begin testing for 5010.
- Ask your clearinghouse if there will be any cost to you for the system change or for staff training.
- Discuss with your practice management vendor and clearinghouse whether the systems will continue to support the current HIPAA version 4010 and 5010 during the transition phase.
- Create a team or assign key staff to work with vendors on practice workflow and other daily transactions.
- Generate a budget for expenses related to training, system changes, and other necessary resources that your practice will need for implementation.
To be forewarned is to be forearmed. Implementation of version 5010 is not optional, and rheumatology practices should begin early testing and implementation well before January 1, 2012 to avoid disruption in patient flow and reimbursements. For additional information, visit www.rheumatology.org/practice or contact Antanya Chung, CPC, CPC-I, CRHC, CCP, at firstname.lastname@example.org or (404) 633-3777, ext. 818.