Doctors’ Time Running Out To Meet HIPAA 5010 Requirements

Doctors’ Time Running Out To Meet HIPAA 5010 Requirements

Effective January 1, 2012 there will be a new HIPAA 5010 version that will be a required for doctors to use for electronic filing.  If physicians don’t use version 5010 for all HIPAA electronic transactions by that date, their claims will be rejected and they won’t be paid.  Doctors are feeling the pressure to get their systems ready for this change.  Many physican practices have not embraced the electronic age as well as other businesses have and are now behind the eight ball, scrambling to meet these new standards.

Medcost.com reported, “The purpose of 5010 is to facilitate the country’s ongoing goal of transitioning to an electronic health care environment by updating the current standards for electronic health care and pharmacy transactions. The updated 5010 versions replace the current versions of the standards and will promote greater use of electronic transactions. This change has been driven by the United States Department of Health and Human Services (HHS).”

There are some helpful resources to show doctors how to prepare for this transition.  GetReady5010 offers free webinars.  The AMA also has some excellent resources. Despite all of these free offerings, many physicians are not prepared for this change. American Med News reported, “Many physicians have not even begun to see if they are compliant with what are known as HIPAA Version 5010 standards. According to a survey released in March by the Medical Group Management Assn., 56% of practices have not scheduled any internal testing for 5010, and 61% have not scheduled any testing with their major health plans. The survey covered 349 practices with 13,290 doctors.”

What’s new in the HIPAA 5010 version? Some of the changes include:

  • Physicians must submit a nine-digit, rather than a five-digit, ZIP code
  • Physicians may distinguish between principal diagnosis, admitting diagnosis, external cause of injury and patient reason for visit codes
  • 5010 set will allow for the inclusion of ICD-10 codes

Nextgen.com listed the following frequently asked questions relate to HIPAA 5010 to help understand requirements.  Click on the links for answers to each of the questions.

  1. What is HIPAA 5010?
  2. Who will need to upgrade to HIPAA 5010?
  3. Why must I upgrade to HIPAA 5010?
  4. How is HIPAA 5010 different from HIPAA 4010?
  5. What are the key dates for HIPAA 5010 and what is the deadline for HIPAA 5010 implementation?
  6. What happens if I’m not ready by the compliance deadline?
  7. Is there a chance for a delay in the compliance date?
  8. What do I need to do to prepare for the upgrade to 5010?
  9. If I finish all of this work before the compliance deadline, can I start to use the 5010 transactions?
  10. What provider transactions are implemented with HIPAA 5010?
  11. Where can you obtain the X12 Technical Reports?
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Is it OK for Doctors to Use Social Media?

  With Twitter breaking the 20 billion tweet record, social media has shown it is becoming the way for people to communicate.  Businesses are using sites like Twitter, Facebook, LinkedIn and others to get their messages across.  Doctors have traditionally been slow to get into some forms of advertising.  Some feel it doesn’t seem professional.  Others just don’t have the time.  However, there are some things that social media could offer for many physicians such as ability to stay in contact with patients, answering common questions, possible virtual visits, and a general enhanced patient relationship.  

    The question may be where to draw the line?   Is it OK to offer medical information online if there is a demand for it?  The New York Times reported: a survey by Pew Internet and American Life Project reported 61% of Americans will go online for health information.   Doctors are looking for guidance as to what is acceptable in terms of how close of a relationship is deemed appropriate in terms of communication.  This has lead to the first set of guidelines ever published on using e-mail in patient care.   Anonymity is a huge issue when dealing with patients and HIPAA (The Health Insurance Portability and Accountability Act).  HIPAA was devised partly to ensure protecting the privacy of Americans’ personal health records by protecting the security and confidentiality of health care information.

    However, helpful information can be shared through social media if it is general in nature and doesn’t involve specific patient information.  Mayo clinic is even tweeting these days.  Are you ready to be friends with your physician on Facebook? Are there better avenues such as LinkedIn or other more professional sites where contact would be a better option?  Michael Lara, MD recently stated that he felt there are 5 social medial tools for physicians that he considers helpful:

  1.  Facebook Practice Page
  2. Google Reader for Medical Articles and News
  3. YouTube Channel for Patient Education Library
  4. Twitter for Connecting with Colleagues
  5. Practice Blog 

    I know a lot of physicians from my 15 years being a pharmaceutical representative and being married to a plastic surgeon.  From my experience, I see that they have a lot on their plates; learning social media may not be a priority for them.  That is not to say they may not benefit from hiring a social media manager.  Wouldn’t it be interesting to see which of your messages gets through to your physician in a timelier manner some day. . . the message you sent where you had to sit on the phone system listening to the recording asking you to push 1 for appointment desk, 2 for billing . . .  or the message that you tweeted to them quickly from your iphone . . .