HIPAA 5010 Requires IT to Do More with Fewer Resources

A hospital's IT project list is most likely an exponential one: Convert to an EHR, transition to HIPAA 5010, coordinate vendor and health plan testing, train staff members on new technology, prove meaningful use, and qualify for incentive payments under the American Recovery and Reinvestment Act. It's enough to make anyone's head spin.

"Institutions are being forced to downsize and limit their scope in today's economy. Never has so much needed to be done with so few resources," says Dan Rode, MBA, CHPS, FHFMA, vice president of policy and government relations for the American Health Information Management Association in Washington, DC.

Deadline is January 2012

The transition to HIPAA 5010 is perhaps the most pressing issue because its compliance deadline is little more than two years away. Providers must be ready to submit claims electronically using the upgraded HIPAA standards by January 1, 2012—nearly one year prior to the October 1, 2013 ICD-10 deadline.

CMS recently held its first national provider education call about HIPAA Version 5010, during which it provided an overview of the updated national code standard for billing software and answered several questions from providers, vendors, and other health information management and health information technology professionals.

The X12 Version 5010 and the National Council for Prescription Drug Programs Version D.0 standards will incorporate more than 500 change requests, resolve ambiguities in situational rules, and provide more consistency across transactions, said Kyle Miller, health insurance specialist in the Office of E-Health Standards Services of CMS, during the call.

New data element requirements

In some cases, version 5010 will also include new data element requirements, said Chris Stahlecker, the director of the Division of Medicare Billing Procedures for CMS, during the call. "Everyone should realize that the software used today to produce the EDI transactions must be modified to exchange the new formats," she added. "In addition, you may discover that your business processes may need to be changed."

Medicare has performed a comparison of the current and new formats that hospitals can use to begin performing a gap analysis and evaluate the impact on routine operations.