Effective January 1, 2012 the federal government has mandated that all covered entities (including providers, clearinghouses and health plans) must transition to the latest version of the Health Insurance Portability and Accountability Act (HIPAA) electronic transaction standards and code sets. The new version of the electronic transaction standards is known as HIPAA 5010. Home Health Agencies as providers are also affected by this new requirement. The HIPAA 5010 requirements apply to all types of claims and claim related transactions. Providers that do not conduct electronic health transactions using Version 5010 as of January 1, 2012, may experience delays in claim reimbursement as a result. To accommodate the ICD-10 code structure, the transaction standards used for electronic health care claims, Version 4010/4010A, must be upgraded to Version 5010 by January 1, 2012.

What is HIPAA 5010?

HIPAA X12 standards, version 5010, is a new standard that regulates the electronic transmission of specific health care transactions. Covered entities, such as health plans, health care clearinghouses, and health care providers, are required to conform to HIPAA 5010 standards. The compliance date for use of these standards is January 1, 2012. It is necessary to implement the new standard to prepare for the transition to ICD-10-CM and ICD-10-PCS. The compliance date for ICD-10 is October 1, 2013.

Benefits of HIPAA 5010

The main benefit of HIPAA 5010 is that it offers consistency of processing for payers and clearinghouses and allows standardization of EDI transactions . The Center for Medicare and Medicaid Services (CMS) has outlined 7 benefits of HIPAA to include:

• Less ambiguity in the implementation guides
• Enhanced usability and usefulness of certain transactions such as referrals and authorizations (X12 and NCPDP)
• Improved utility of the NCPDP standards, compliance with Part D requirements
• Supports standardization of companion guides across the industry
• Supports increased use of EDI between covered entities
• Supports e-health initiatives now and in the future
• Provides infrastructure on ICD-10 and Present on Admission Indicator

What is Axxess doing for HIPAA 5010?

HIPAA updates from version 4010 to 5010 are well underway at Axxess. Axxess has a dedicated team working to become fully compliant with the new requirements. Axxess has successfully kept thousands of providers compliant with new regulations and has a proven track record of providing timely updates to keep our customers successful. Axxess is finalizing testing on HIPAA 5010 with all the FIs and other clearing houses also. All claims generated from Axxess’ software system will be HIPAA 5010 compliant well in advance of the January 1, 2012 date. Axxess customers will again enjoy the benefit of using the leading home health software product in the country.

What you need to do?

Home Health agencies that utilize Axxess’ industry leading home health software to generate claims will enjoy a seamless transition. There will be no disruption at all to their operations thanks to the work of our dedicated team. They will be ready way in advance for the full implementation of HIPAA 5010. The updates are provided free and automatically to all our customers. Providers that are not compliant by January 1, 2012 may see a delay in their claims reimbursement.

Please visit our website frequently or subscribe to our news and updates page to receive information on upcoming webinars and seminars on how best to facilitate this transition to HIPAA 5010.

Providers utilizing other software vendors will need to contact their vendor to know what steps are being taken to ensure that their operations are not adversely affected.

For organizations that utilize other software vendors, we have provided a list of questions to ask your vendor:

1. Will you upgrade your current system to accommodate Versions 5010 and D.0 transactions?
2. Will the upgrade include acknowledgement of transactions 277CA and 999?
3. Will the upgrade include a “readable” error report produced from 277CA and 999 transactions?
4. What is the time frame for when you will be capable of supporting Version 5010 transactions exchange?
5. Will you be able to support both Version 4010A1 and Version 5010 transactions exchange concurrently?
6. When will the current system accommodate both the data collection and transactions conduction for Versions 5010 and D.0?
7. When will the upgrades be available?
8. Will there be a charge for the upgrade?
9. When will the software installation to the systems be completed?
10. Will the transition be completed before the January 1, 2012 compliance date?
11. Will there be sufficient lead time to test the new software before the January 1, 2012 compliance date?

Based on your software vendor’s responses to the questions above, evaluate the impact to routine operations and begin planning for training and transition.

Additional steps to prepare include:

How You Can Prepare:

• Educate your staff regarding HIPAA 5010. Billing staff especially need to know about the new data reporting requirements. For example, the provider billing address on Professional claims can no longer be a P.O Box.
• Talk to your clearing house to determine if there will be any fees for upgrades and when you can begin testing the new transaction sets Talk to your clearinghouse – Ask about upgrades/fees and when you will be able to test the new transaction sets.
• Contact your fiscal intermediary (e.g. Palmetto, Cigna, NGS or Anthem) to determine testing requirements and timelines. Talk to you FI – Find out testing requirements and timelines.
• Allow adequate time to test the new transaction sets prior to the implementation date of January 1, 2012.

For additional information, please visit the following websites:

https://www.cms.gov/ElectronicBillingEDITrans/18_5010D0.asp
http://www.cms.gov/Versions5010andD0/40_Educational_Resources.asp#TopOfPage
http://www.cms.gov/Versions5010andD0/Downloads/Readiness_1.pdf
https://www.cms.gov/ICD10/05a_ProviderResources.asp
http://www.cms.hhs.gov/ElectronicBillingEDITrans/18_5010D0.asp
http://www.cms.gov/Versions5010andD0/downloads/w5010PvdrActionChklst.pdf