Sep 28, 2011

Nine Things to Do NOW to Prepare for HIPAA 5010 Conversion

If you do not upgrade your electronic billing systems to comply with the HIPAA 5010 electronic claims standards by Jan. 1, Medicare, Medicaid, and the commercial insurance carriers will not pay your claims. It's as simple as that. Here are nine things you can do now to make sure you get paid for the care you provide in 2012:

  1. Contact your vendors - for your practice management system, electronic health record system, and/or your claims clearinghouse -- to ensure your software is upgraded for 5010 compliance. Questions to ask and a list of the most popular vendors in Texas.
  2. Check the 5010 Update pages for Medicare, Medicaid, and health insurance payers.
  3. Identify changes to data reporting requirements.
  4. Once you have the upgrades, test the system to ensure claims are going through – whether you process through a clearinghouse or directly with the payer.
  5. Identify potential changes to existing practice work flow and business processes.
  6. Identify staff training needs.
  7. Budget for implementation costs, including expenses for system changes, resource materials, consultants, and training.
  8. If you are looking for a new system, consider upgrading to a companion practice management/electronic health record system. Your HIT Regional Extension Center (REC) might be able to help with planning.
  9. Listen to the audio highlights from TMA's HIPAA 5010 Tele-Town Hall meeting on Sept. 22, 2010. TMA President C. Bruce Malone, MD, moderated the discussion, which featured presentations from TMA expert staff. This half-hour Podcast TMA session covers the details of the conversion, how to prepare to upgrade your practice management or electronic health record systems, how to develop an action plan, and the impact on your business functions.

Sep 23, 2011

Tele-Town Hall Offers 5010 Advice

Shannon Moore, Dr. Malone, and Steve Levine
In case you missed it, here's an audio recap of TMA's Tele-Town Hall Meeting on the HIPAA 5010 electronic claims standards, recorded Sept. 22, 2011. TMA President C. Bruce Malone, MD, moderated the discussion, which featured presentations from TMA expert staff. Listen in to learn the details of the conversion, how to prepare to upgrade your practice management or electronic health record systems, how to develop an action plan, and the impact on your business functions.

Download the recording now.

In addition to Dr. Malone, participants included:
  • Lee Spangler, JD, TMA vice president, Medical Economics;
  • Shannon Moore, director of TMA’s Health Information Technology Department; and
  • Laura Palmer, a TMA practice management consultant
Lee Spangler and Laura Palmer
Here's an excerpt from Dr. Malone's opening remarks:
One of TMA’s goals throughout the year is to keep you up to date on new rules and regulations coming down from the federal government. It’s critical that your electronic billing system be updated by January 1, 2012, to comply with the HIPAA 5010 electronic claims standards. If NOT — Medicare, Medicaid, and the commercial insurance carriers will NOT pay your claims. This could seriously hurt your practice.

Why do we need to be HIPAA 5010 compliant, anyway? The Health Insurance Portability and Accountability Act of 1986 — or HIPAA — is the culprit. In addition to protecting our patients’ privacy, it required the federal government to institute “administrative simplification” to standardize the submission of electronic health insurance claims.

This means come January 1, the electronic standard for submitting health insurance claims will change. If you or your billing company is not submitting your claims under the new standard — known as the 5010 standard — Medicare, Medicaid, and health insurers will ignore your claims and YOU WILL NOT BE PAID.

Every physician who transmits a claim electronically for payment or who has someone else transmit a claim electronically on his or her behalf must comply.

Sep 13, 2011

New Be Wise — Immunize Toolkits Available

TMA's Be Wise — Immunize program offers two toolkits to help physicians provide the best vaccination care to their young and adolescent patients. TMA recently updated the Physician Manual for Children and Physician Manual for Adolescents . Both toolkits are free for TMA members.

Required Information for Meaningful Use

One of the core "meaningful use" measures intended to engage patients and families requires you to give patients specific information. This timely information can enhance patient satisfaction, increase patient knowledge, reduce anxiety, and improve follow-up compliance.

Sep 12, 2011

Received a RAC Records Request or Repayment Letter?

TMA is receiving more and more calls from physician offices that have received a records request or repayment letter from Connolly, Inc., the Medicare Recovery Audit Contractor (RAC) for Texas. Here's what you need to know if it happens to you.

Doctors: Answer Your Phone if You Want to Get Paid

Come Jan. 1, 2012, all health insurers – Medicare, Medicaid, and private payers – will stop paying claims from any physicians who have not upgraded their electronic billing systems to comply with the HIPAA 5010 electronic claims standards. The U.S. Department of Health and Human Services requires all "covered entities" (physicians, clearinghouses, insurers, and others with access to digital personal health care data) to convert to the new 5010 transaction set by Jan. 1. These are the electronic transactions used to transmit patient, physician, and provider data among those covered entities.

To help you avoid disaster, the Texas Medical Association will conduct a Tele-Town Hall Meeting on the new standards at 8 pm (CDT) on Thursday, Sept. 22. TMA President C. Bruce Malone, MD, will moderate the discussion, which will feature expert presentations from TMA physician leaders and staff. Dr. Malone will call you at your home telephone number and invite you to stay on the line to learn about HIPPA 5010.