Will Your Therapy Management System Be HIPAA 5010 Compliant?
A New Standard......
The electronic transmission of specific healthcare transactions starting January 1st, 2012 now has a new standard. The new HIPAA 5010 file format must now be used for the electronic submission of:
- Professional & Institutional Claims (837)
- Eligibility (270/271)
- Claim Status (276/277)
- Remittances (835)
- As well as many other healthcare transactions
Therapy billing software companies who submit CMS-1500, UB-04 claims, and other healthcare related transactions to a clearing house may not be immediately affected by the new 5010 standards going into effect January 1st, 2012. This is because many clearing houses plan to convert print image and other legacy file formats to the 5010 format well beyond this deadline. For example, our
CarePoint Outpatient Rehab Management Software submits electronic claims and other transactions to the Gateway EDI Clearing House.
Gateway EDI will be converting these healthcare transactions to the HIPAA 5010 format for us.
A Word Of Caution From Our Friends At CMS….
The Centers for Medicare & Medicaid Services (CMS) Website states.....
“ICD-10 codes must be used on all HIPAA transactions, including outpatient claims with dates of service, and inpatient claims with dates of discharge on and after October 1st, 2013. Otherwise, your claims and other transactions may be rejected, and you will need to resubmit them with the ICD-10 codes. This could result in delays and may impact your reimbursements, so it is important to start now to prepare for the changeover to the ICD-10 codes.”
It is imperative that companies confirm that they can transition to the 5010 standards by the January 2012 compliance date and make appropriate and timely decisions to do so. This includes being able to handle the new ICD-10 code sets, which is scheduled to be implemented in the fall of 2013.
Can Your Therapy Billing System Handle ICD-10 Code Sets?
ICD-9 Format
- 3-5 Characters
- First Character is alpha or numeric
- Characters 2-5 are numeric
- Always at least 3 characters
- Use of a Decimal after 3 characters
ICD-10 Format
- 3-7 Characters
- Character 1 is alpha
- Character 2 is numeric
- Character 3-7 are alpha or numeric
- Use of decimal after 3 characters
- Use of dummy placeholder “X”
- Alpha characters are not case-sensitive
Our CarePoint Outpatient Rehab Software already accommodates the ICD-10 format because our diagnoses table on the CarePoint Database allows for 7 characters. The new ICD-10 codes simply need to be uploaded to this table for our clients when the regulations become effective.