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:
- 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.
- Check the 5010 Update pages for Medicare, Medicaid, and health insurance payers.
- Identify changes to data reporting requirements.
- 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.
- Identify potential changes to existing practice work flow and business processes.
- Identify staff training needs.
- Budget for implementation costs, including expenses for system changes, resource materials, consultants, and training.
- 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.
- 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.