Medical Billings New 5010 HIPPA Version

The new changes for Medical Billing that are taking place in 2012. There is always learning to do in this field and sometimes we don’t have all the answers.

The newest changes to impact Medical Billing is the implementation of the version 5010. As we rang in the new year we rang in new laws, January 1, 2012 marks the deadline for the new version of the HIPAA transactions. The version 4010 has been in use since 2003 and the Centers for Medicare and Medicaid Services (CMS) are requiring all HIPAA covered entities, which includes physicians who conduct any of the transactions named in HIPAA electronically (i.e. claims or remittance advice), to begin using Version 5010 starting on January 1, 2012.

We had been getting emails about this as well as Medicare and other websites reminding providers and staff of this upcoming change. Nevertheless, there are always going to be those not quite ready for the change. Many providers have yet to upgrade their billing management software. I do not need to upgrade mine and those that use an outside clearinghouse should not have to upgrade theirs. It can be very costly unless you have ongoing continued monthly software support which is often times includes any new releases and updates that have come out.

The CMS which is the federal agency overseeing this compliance has agreed to not levy any punishments for a few months giving more providers more time to get ready. Most providers who send claims directly to Medicare are the ones that need to start testing if not already done; not to mention now, having to submit a transition plan. Other options if not interested or unable to afford a software upgrade is, signing up with a clearinghouse or Medical billing service to transmit your claims for you. This option should be considered if a software upgrade becomes to costly. Given hard times and the constant reimbursement reduction threats, not all providers can afford it and remain in private practice.

If you are currently with a clearinghouse and your remittance address is a post office box be sure to talk to your clearinghouse or Billing service as those will not be accepted with this new version. You must register the POB with the clearinghouse so remittances will continue to go through to that POB but on the claim, forms reflect the physical address. This can and will delay the claims being sent or processed until confirmation is received that registration in completed.

This should help everyone to understand a little better this newest change. There are still more to come.