“Physicians need to prepare now, or they’ll be working for nothing next year.”


need to upgrade your hardware to support new technology requirements.


• Check with your practice management system vendor to en- sure your system complies with HIPAA 5010. Most vendors have HIPAA 5010 information, including testing timelines, on their websites, or you can call your representative. The vendor should be testing 5010 with the electronic data in- terchanges it supports. Links to these sites are posted on the 5010 Resource Center on the TMA website.


• Check with your electronic data interchange (EDI) vendor or clearinghouse to ensure compliance. This information also will be available on the EDI website. The EDI vendor tests 5010 with the payers it supports.


• If your practice submits claims directly to a payer, you must work with the payer to schedule transmission testing.


• Once you’ve confirmed compliance with the practice man- agement system and EDI vendors, it’s time to coordinate test transmissions with your EDI.


CMS has a guide to communicating with vendors about


ICD-10 and HIPAA 5010 available online, www.cms.gov/ ICD10/Downloads/ICD10TalkingtoVendorforMedicalPractic es20100409.pdf. Dr. Wiesenthal’s practice successfully completed Level I


testing and is now doing Level II end-to-end testing, which re- quires practices to submit past claims data in the 5010 format to their trading partners. Level I testing entailed demonstrat- ing the practice could create and receive compliant transac- tions internally. “So far we’ve submitted 2009 claims to our clearinghouse


for Level II testing, and we haven’t received notice of any prob- lems,” Dr.Wiesenthal said. When transitioning to HIPAA 5010, Dr. Wiesenthal says,


practices must pay attention to detail. For example, HIPAA 5010 requires updating of all facility addresses in a system with a nine-digit ZIP code. And physical addresses must re- place post office box addresses. To view the CMS side-by-side comparison of the current and new transaction formats, visit www.cms.gov/ElectronicBillingEDITrans/18_5010D0.asp. Dr. Moore’s practice plans to test the EHR system soon to


ensure it’s capable of transferring patient information in 5010. He encourages physicians to allow ample time to assess and fix any problems they encounter in the tests. CMS conducted a National 5010 Testing Day June 15 and


hosted National Testing Week Aug. 22–26 to help physicians prepare for the switch to HIPAA 5010. TrailBlazer Health En- terprises LLC compiled a list of the top 10 errors for HIPAA


14 TEXAS MEDICINE November 2011


Version 5010 claims, www.trailblazerhealth.com/Tools/No tices.aspx?DomainID=1&ID=14430. Common errors include invalid ZIP codes, addresses, National Provider Identifier num- bers, and tax identification numbers. Billy Quarles, media relations specialist for BlueCross BlueShield of South Carolina, says physicians should consult TrailBlazer’s 5010 Information page, www.trailblazerhealth .com/Electronic Data Interchange/5010.aspx, for guidance on fixing problems before Jan. 1, 2012. Texas physicians also can contact TrailBlazer’s EDI Helpline at (866) 749-4302. For information on Medicare and Medicaid, visit the CMS


Versions 5010, D.0, and 3.0 Overview page, www.cms.gov/ Versions5010andD0. Remember: HIPAA 5010 is not a Medicare-only program.


All payers must comply. Check the websites for each of your private payers to find testing tips, timelines, and training spe- cific to them. The links to the sites are posted on the 5010 Resource Cen- ter on the TMA website at www.texmed.org/5010.


5010 holds promise, risk


Embracing the HIPAA Version 5010 transaction standards by fully integrating it into your work systems and workflow — rather than merely complying with it—will put your practice on the right track. For instance, Version 5010 corrects many of the flaws of the 4010 version. Since Version 4010’s launch in 2003, software developers have tweaked and patched it to its limits. Version 5010 incorporates hundreds of changes the medical community has asked for. Here are some of the changes your billing staff will find in the new system:


• Loop 2010AC: addition of the pay-to plan; • SBR (subscriber) loop: allows eight additional payers be- yond primary, secondary, and tertiary;


• Loops 2010BC and 2010BD: deletion of the responsible party and credit or debit card; and


• Modifications to the HI segment to allow submission of ICD-10 diagnosis codes.


Physicians can begin to realize the administrative simpli-


fication and subsequent savings that HIPAA promised. For example, authorizations will be streamlined, saving time and hassle on the phone for physicians and staff. Dr.Wiesenthal hopes the switch to HIPAA 5010 will lead to


improved patient care, seamless workflow, and faster claims processing.


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