The deadline for transitioning electronic transactions to the updated 5010 version of the Health Insurance Portability and Accountability Act (HIPAA) transactions standards is July 1, 2012. The Centers for Medicare & Medicaid Services (CMS) had previously moved back the enforcement date to allow the industry more time to convert to the new format. CMS now believes that a sufficient number of practices have effectively made the transition and physicians will begin seeing rejected claims as of July 1, if they are not submitted in the new format. You will be required to conduct electronic transactions such as claims submissions, eligibility verification, claims status, remittance advice and referral authorizations using the updated transaction standards.
If you have not successfully converted your programs to 5010, consider using the free CMS software programs PC-Ace Pro 32 (for Medicare claim submission) and EasyPrint (for Medicare electronic remittances). Both programs are available for download from the Palmetto GBA website, www.palmettogba.com/j1b. Click on EDI in the left menu, then on "Software and Manuals."
Commercial payors will also require practices to submit electronic claims in 5010 format on July 1.
SFMS/CMA surveyed the major payors in California to determine their claim submission requirements. While some did require 5010 on January 1, others allowed for contingencies.
By Amy Berlin, MD
If you are thinking about adopting an EHR in your practice, there is one thing you cannot do enough of: Plan. Here are some (free) resources to get you started.