Magazine article Medical Economics

Are We in Denial?

Magazine article Medical Economics

Are We in Denial?

Article excerpt

The big announcement coming out of the Medical Group Management Association (MGMA) annual meeting this year wasn't the introduction of a new electronic health record (EHR) system or the latest, greatest billing and practice management system. It was a call to arms from MGMA itself.

According to research conducted by the organization, a significant number of physicians have yet to implement Health Insurance Portability and Accountability Act (HIPAA) 5010 electronic transaction standards in their practices.

How can this be, when the deadline to implement HIPAA 5010 is January 1, 2012?

HIPAA 5010

Congress established data interchange rules by which all electronic claims transactions must be transmitted when it passed HIPAA in 1996. In 2009, the new 5010 standards were created to reduce redundancy and increase uniformity of the data exchanged to make it easier for "covered entities" to do business.

The Centers for Medicare and Medicaid Services (CMS) defines covered entities as:

* Healthcare providers who conduct certain transactions in electronic form,

* healthcare clearinghouses, and

* health plans.

HIPAA 5010 not only defines how claims data must be transmitted between healthcare providers and health plans; it's also required to be in place before implementing ICD-IO code sets. Without ICD-IO codes, your billing systems will not be able to submit claims after January 1, 2013. Just one short year after the January 1, 2012, HIPAA 5010 deadline.


According to MGMAs research:

* 4.5% of practices have 5010 fully implemented,

* 50% say they're 26% to 99% finished, and

* 40% say they're only 25% finished.

"It is clear that a significant number of medical groups will not have the ability to transmit claims and other electronic transactions using the Version 5010 format by the January 1 deadline," said Susan Turney, MD, MS, FACP, FACMPE, MGMA president and chief executive officer. …

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