“If I order a CT scan and can get it approved faster, that will expedite care for my patients and lead to a higher level of care,” she said. She acknowledges, however, that the transition is an enor- mous undertaking. “It sounds like a lot of pieces have to fall right into place in a short amount of time for this transition to run smoothly. It will take a concerted effort among many groups with different systems,” she said. Dr. Moore says the HIPAA 5010 standards for electronic transactions could improve a practice’s business operations. “I think there is the promise of efficiency with version 5010, and it could pave the way for widespread use of EHRs,” he said. “I’m hopeful this change will lead to faster payments and more transparent claim processing.” The new electronic transactions standard also could facili-
tate reporting clinical data for quality performance measures, a driving factor for future payment of claims and performance bonuses, he says.
He admits the transition to 5010 places a technological
burden on many physician practices. He and his wife, Angela Moore, MD, a dermatologist, rely on their office manager to keep their EHR up to date. “We lean heavily on our office manager, who joined our staff when we transitioned to an EHR eight years ago. The office manager has kept up with the HIPAA 5010 requirements and has been asking questions of our vendor and clearinghouse,” Dr. Moore said.
Upgrading a practice management system to comply with
HIPAA 5010 requirements may come with a hefty price tag for some practices. Dr. Moore says his EHR vendor contract includes periodic upgrades at no additional charge. “Having a service contract that assured us of updates and a vendor that’s large enough to deal with federal mandates have been helpful,” he said. TMA’s electronic medical record comparison tool, www.tex
med.org/emrtool, includes information on costs associated with purchasing EHRs for solo-, two-, and 10-physician prac- tices. It doesn’t feature upgrade costs, as they vary among ven- dors. Physicians should contact their EHR and practice man- agement system vendors to ask about the price of upgrades. Some companies include upgrades in their annual license fees. Mike Moskovitz, vice president of health care lending at SNB Bank of Austin, says physicians applying for a loan for hardware and software purchases should allow 30 days for ap- plication processing. They will need to submit financial state- ments and evidence they are able to repay the loan. “When making large asset purchases, physicians need to consult their financial advisors,” he said. “They should typi- cally expect to pay back the loan over a 48- to 60-month term.” AMA warns that despite the health care industry’s best ef- forts to prepare for the 5010 compliance deadline, risks re- main. Practices should anticipate unexpected complications that could cause cash flow interruptions. AMA suggests physicians take the following precautions to keep payment flowing to their practices after Jan. 1, 2012:
Eight steps to HIPAA 5010
TMA crafted the following eight-step action plan you can use to achieve Health Insurance Portability and Accountability Act (HIPAA) 5010 compliance.
1. Contact your vendors — for your practice management system, electronic health record (EHR) system, and/or your claims clearinghouse — to ensure they upgraded your software for 5010 compliance. Visit
www.texmed.org/5010 for a list of ques- tions to ask and a list of the most popular vendors in Texas.
2. Check the 5010 Update pages on the TMA website (
www.texmed.org/Template.aspx?id =22446) 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 clearing- house or directly with the payer.
5. Identify potential changes to practice workflow and business processes.
6. Identify staff training needs.
7. Budget for implementation costs, includ- ing 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/EHR system.
November 2011 TEXAS MEDICINE 15
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