The looming compliance deadline has come and gone. Beginning on January 1, 2012, the health care industry begun implementing HIPAA 5010, and HIPAA covered entities are now required to conduct electronic transactions using the 5010 upgrade. This includes eligibility, claims submission, referral authorizations, remittance advice and other electronic transactions performed by covered entities. Institutions that haven’t been impacted by the challenges of the transition will soon begin to notice increased claim rejections in the coming months. Below are best practices for becoming compliant to avoid rejected claims, payment interruptions and other industry challenges.
Learn how the 5010 format will impact new claims data
Although your clearinghouse or vendor can assist in converting your claims to adhere to the 5010 standard, the data used is still provided by your institution. For example, submitting claims that do not include the correct address and zip code requirements will not be converted and sent for payment. Reaching out to other practices within your specialty will help you to identify possible challenges, and can provide resolution to those challenges without exposing your practice to the “pain” firsthand. When a rejection occurs, monitor the rejections while paying close attention to any address related issues (i.e. remittance, EDI), to ensure claims are reimbursed without delays.
Monitor rejection reports to identify these key factors (not an all inclusive list):
· Ambulance claims—pick-up and drop-off locations must be reported, as well as the number of patients transported in the vehicle.
· Drug reporting—claims for injected medicine must include additional drug information as well as the HCPCS code.
· Billing provider address—5010 guidelines mandate the need to enter the billing provider as the physical address. PO Boxes or lock box addresses will need to be reported as “pay-to” addresses, when needed for payments and payer correspondence.
· Zip codes—providers must now submit claims with a nine-digit zip code when reporting the location of service facilities and billing providers. This includes the five-digit zip code with the correct four-digit extension.
Conduct thorough testing, both internally and externally
All changes made will not go according to plan. Therefore, internal testing should be performed to determine if the software changes for implementing HIPAA 5010 transactions are functioning correctly. Testing will allow you to discover and resolve any possible system issues that could occur as a result of a 5010 transaction, and can help determine if a failure is internal or external. Two levels of testing include:
· Level 1 Testing: A practice is able to create and receive 5010 transactions successfully, within the organization.
· Level 2 Testing: A practice is able to send and receive 5010 transactions externally, with business associates, clearinghouses, payers and other partners, using the same channels as those used to conduct current transactions.
Encourage the use and expansion of automation
Automation can be used to improve the internal and external testing process. Automation allows completing these tasks in a shorter period of time with more consistency across the board. Creating scenarios to test the processes which are most vital to production will prove beneficial for time-strapped institutions, as opposed to testing every single scenario.
Although the Centers for Medicare and Medicaid Services announced that enforcement actions against non-compliant organizations will not take place until March 31, 2012, there is no breathing room remaining to become complacent. The entire HIPAA covered medical industry should begin implementing HIPAA 5010 by working with business associates and other collective organizations within the industry, to ensure successful testing and a painless transition. Refusing to move towards compliance now will inevitably cause administrative nightmares and payment headaches in the near future.
Does your practice have the proper measures in place for the implementation of HIPAA 5010? Find out today by initiating iATROS Healthcare Solutions' complimentary practice analysis.
