As of January 1, all electronic administrative transactions in the U.S. healthcare system should comply with the updated standards of HIPAA Version 5010.
Hopefully you upgraded your software, revised your templates and educated yourself on the 5010 changes in time for the conversion deadline.
But even if you’re pretty sure you covered all your bases before last year’s end, now is the time to double-check the details. The Centers for Medicare & Medicaid Services (CMS) won’t track you down to enforce compliance until July, but if there’s a hole in your process where a violation is taking place now, you need to catch the issue in time to resolve it before CMS starts applying penalties.
Follow these pointers from Power Your Practice to keep violations from slipping through the cracks.
1. Make Sure You’re the Billing Provider
Under 5010 standards, the company or organization that provides the billable service is the one that should be listed as the billing provider – not the clearinghouse or billing company.
2. Check That Address
To be HIPAA 5010 compliant, all transactions must include the actual street addresses of the service facility and billing provider, plus their complete 9-digit zip codes. PO boxes are no longer acceptable.
3. Be Consistent With Your NPI
If you’re not reporting under the same National Provider Identifier to all of your payers, you’re not 5010 compliant. Identify your official NPI and make sure you use it in every transaction.
4. Mark the Minutes
All anesthesia services must be reported in minutes, not units, under HIPAA 5010. If “units” remain on your anesthesia forms, update them ASAP.
5. Consult With Your Trading Partners
Don’t assume everyone’s ready to receive 5010 transactions. Find out if one of your payers or clearinghouses is using CMS’ non-enforcement window as an excuse to wait until March to upgrade their systems.
6. Remember the Diagnosis Code
It may have been rare that you sent a claim without one, but it’s worth reminding your coders: Under HIPAA 5010, every single claim must contain a diagnosis code.
7. Double-check: Subscriber/Patient
The individual who has a unique member identifier from your payer is the one you must list as the subscriber in your transactions. If the policyholder is the patient, list him only as a subscriber – leave “patient” blank. If a dependent is your patient, list the policyholder as the subscriber and the dependent as the patient.
8. Check for Your Tax ID
The billing provider’s tax ID is required on all 5010 claims. Since the care provider is now always the billing provider, be sure you’re putting your practice’s tax ID on your transactions.
9. Review How Many Codes Point to Your Service Line
HIPAA 5010 increases the number of diagnosis codes allowable on a claim from eight to twelve, but only a maximum of four of those codes can be linked to a service at the service line level. Should a service relate to more than four of your patient’s diagnoses, point to no more than four of them when billing that service line.
10. Get Validation of Your Compliance
If you have any doubts about the HIPAA 5010 compliance of your transactions, get in touch with a validation service. They’ll confirm whether you’re following implementation guidelines and may be able to help you make last-minute changes to your forms or processes.
Are you transacting in the HIPAA 5010 standard?
Madelyn Young is a Content Writer for CareCloud and an expert on practice management, medical billing, HIPAA 5010, ICD-10 and revenue cycle management. You can read her work on Power Your Practice and the CareCloud Blog. Contact Madelyn with story suggestions, contributor articles, or any other feedback at madelyn@poweryourpractice.com or follow her on Twitter @madelyn_young.
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