COST IMPACT OF THE IMMINENT HIPAA 5010 AND ICD-10 IMPLEMENTATIONS WILL BE MONUMENTAL ON ALL HEALTHCARE PROFESSIONALS!

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HIPAA 5010

HIPAA 5010 is the next step towards implementing Administrative Simplification between Healthcare Covered Entities – generally Healthcare Providers, Payers and Clearinghouses.  HIPAA 5010 paves the way for further standardization providing Trading Partners better communication and more efficient, less expensive business processes.Current HIPAA transactions are at version 4010A1.  In January 2009, CMS mandated conversion to HIPAA version 5010 by January 1, 2012.  While HIPAA 5010 is not a rewrite of 4010A1,there are significant changes.  For example, the following generic enhancements have been made to all of the HIPAA standards (TR3):

Consistent TR3 formats – standardized front matter and appendices
Consistent implementation instructions
Clearly defined situational requirements
Addresses approximately 500 industry requested changes
5010 will reduce the need for Companion Guides by providing clearer instructions in the TR3 guides themselves
Major Functional Changes
Supports ICD-10 (There is no way to send an ICD-10 diagnosis code in any of the 4010A1 transactions. HIPAA 5010 supports ICD-9 only, ICD-10 only and dual usage of ICD-9 and ICD-10)
Clarifies National Provider ID (NPI) Instructions
The current 4010A1 standards give direction on how to report NPIs. 5010 states which NPI should be sent. The instructions state that a provider always reports NPI at the lowest level of specificity.