By Jim Denny
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Believe it or not, we are half way through the HIPAA Version 5010 noncompliance grace period. In a month and a half, on April 1, 2012, the Centers for Medicare and Medicaid (CMS) will begin enforcing and penalizing any medical organization that is not submitting electronic claims in the appropriate 5010 format. Needless to say, if you are not compliant and are hit with these penalties, they can quickly become an unnecessary drain on your bottom line.
What should your organization be doing to avoid these penalties and ensure you are in compliance? CMS has outlined a few tips for organizations that still need to transition to 5010, including engaging in both internal and external testing phases to ensure compliance.
Internal testing is necessary to prove your systems are capable of supporting the new claims format and to ensure your staff is well-trained on the changes associated with 5010. The external testing phase should be conducted to confirm claims can be successfully transmitted to outside partners such as software vendors, clearinghouses, billing services and payers.
In addition to testing, there are also several questions you can ask your partners to make sure you’re both on the same page about the transition, including:
- Will there be an added cost with the upgrade to 5010?
- Will versions of your software be updated, and will we need to update ours?
- Do you have training available to help our staff make the transition?
You can read all of the tips from CMS in this article from the American Academy of Professional Coders (AAPC).
