Are you ready for the Jan. 1 HIPAA compliance deadline?
22 December 2011
The Jan. 1, 2012 compliance deadline to use the new version of the standard electronic Health Insurance Portability and Accountability (HIPAA) transactions, Version 5010, is rapidly approaching. Although Version 4010 has been in use since 2003, the Centers for Medicare and Medicaid Services (CMS) will soon require that all HIPAA-covered entities, which includes physicians who conduct any of the transactions named in HIPAA electronically, begin using Version 5010.
CMS recently announced that it will not enforce compliance of the Jan. 1 deadline until March 31 but they still encourage all physicians and other HIPAA-covered entities to make every effort to comply with the use of the new standards.
Physicians, clearinghouses and third party billers who submit claims directly to Medicare are required to test with Medicare before claims can be processed using the 5010 format. Medicare remains focused on ensuring that all submitters have tested successfully and that claims processing is not interrupted. If you are a physician who sends claims directly to Medicare without the use of a billing service or clearinghouse, make sure you complete the following steps by Dec. 31:
If you HAVE NOT tested by Dec. 31, 2011: You are required to submit a "transition plan" to your Medicare contractor that details your plans for moving to 5010 and when you think you will be able to test with Medicare. You will have 30 days to do this once you have been contacted by your Medicare contractor.
- No prescribed format for transition plan: It can be sent via letter, e-mail or fax and can be a brief explanation of your transition plans.
- Keep evidence plan was submitted: Submitters are strongly encouraged to retain evidence that a plan was sent (i.e. return receipt email, fax transmission confirmation, copy of an e-mail).
- All submitters must test: Unless submitters have tested with their Medicare contractor, even if you submit compliant 5010 transactions, your claims will be rejected.
If you HAVE tested successfully by Dec. 31, 2011: You will be contacted by Medicare and told you have 30 days to move over to use of the 5010 standards. Submitters who have not yet tested with Medicare prior to the compliance date will be contacted and asked to submit the transition plan described above.
Physicians who rely on a billing service or clearinghouse to submit their claims to Medicare are NOT required to file a transition plan to Medicare. These physicians should contact their billing services or clearinghouses to determine their ability to generate the physician’s claims and other transactions using the Version 5010 format.
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