|Shannon Moore, Dr. Malone, and Steve Levine|
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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|
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.