Have You Completed Your 5010 Implementation?

There are steps to ensure that your upgrade is a smooth one: establish a line of credit and check partner readiness

Recently, the Centers for Medicare & Medicaid Services (CMS) announced it will not initiate enforcement action against any HIPAA covered entity for an additional three (3) months, through June 30, 2012,for the updated HIPAA transaction standards (ASC X12 Version 5010, NCPDP Versions D.0 and 3.0).

Although much progress has been made in the successful receipt and processing of claims in the Version 5010 format, CMS is aware that there are still challenges and issues impeding an industry wide upgrade.

During these additional 90 days in which CMS will not initiate enforcement penalties, you should collaborate more closely with trading partners on appropriate strategies to resolve any remaining problems. Two steps providers can take to ensure a smooth upgrade are:

1. Establishing a line of credit: To avoid potential cash flow disruptions, providers should consider establishing or increasing a line of credit. By doing so, they can prepare for possible delays and denials in payer claims reimbursements if noncompliant Version 5010 transactions are submitted. 
2. Check partner readiness: Because a provider's Version 5010 upgrade can be dependent upon his or her vendor, it is important for providers to be aware of their vendor's transition status. If your vendor is behind schedule for Version 5010 adoption, get confirmation of their timeline to be compliant, and encourage them to take action so that your system will be prepared to handle your claims.  

Other steps to prepare for the Version 5010 upgrade can be found on the Version 5010: Ensuring a Smooth Transition Fact Sheet, which provides an overview of several actions providers can take to maintain continuity of operations for their practices as they prepare to complete Version 5010 testing.

Keep Up to Date on Version 5010 and ICD-10.
Please visit the ICD-10 website for the latest news and resources to help you prepare, and to download and share the implementation widget today!

HIPAA 5010 Transition Problems

http://www.grouponehealthsource.com/blog/bid/53819/HIPAA-5010-Transition-Problems

Many Physicians experience problems during 5010 Transition

On January 1, 2012, all electronically submitted HIPAA covered health insurance claims were supposed to be submitted using the 5010 platform.  Although CMS had previously announced it would not take any enforcement action against any plan or provider who was not 5010 ready until after March 1, 2012, the January 1 deadline for compliance remained in effect.

Perhaps the most consistent reports heard during the transition were that the problems – whatever they were – were someone else’s fault.  Clearinghouses blamed Health Plans (both commercial and government) and Health Plans blamed providers, clearinghouses or practice management software programs.  There were so many fingers being pointed at others over the past two months, it is a wonder there wasn’t a major up-tick in the number patients showing up in ERs with broken fingers!

5010 Update — How the Government and Blues have botched the 5010 claims transition (Where is my check, and how do I make payroll?)

http://blog.healthfusion.com/index.php/health-topics/health-policy/5010-update-how-the-government-and-blues-have-botched-the-5010-claims-transition-where-is-my-check-and-how-do-i-make-payroll/

Using social media to build your practice

http://www.virtual-strategy.com/2012/03/07/tips-using-social-media-effectively-healthcare

Is this Billable Time?

http://www.mcknights.com/is-this-billable-time/article/231098/

A clean sweep

http://www.chiroeco.com/chiropractic/news/12352/1669/a%20clean%20sweep/

Physicians Must Post Prices For Walk-Ins Says New Law

Doctors may be shocked to find out they could be fined up to $1,000 a day for not posting fees for patients without appointments. The new "Health Care Transparency Bill" just passed by the Florida Legislature, requires the posting of rates charged by urgent care centers, walk-in clinics and any physicians who accept walk-ins. According to the new law, prices for the top most common procedures of the clinics must be displayed visibly in order to avoid steep fines.

Physicians and other health care providers can learn how this law applies to their practices and how to avoid compliance traps at a free webinar, "Posting Your Prices: Does the New Law Apply to You?" on Tuesday, July 12, 2011 from 5-6 p.m. To register, go here.

Although the law took effect on July 1, 2011, many health care providers are unaware of the new regulation and its possible pitfalls, says Lester Perling, a partner with the Fort Lauderdale office of the statewide law firm Broad and Cassel.

"Although intended for Urgent Care Centers, this law also could apply to any clinic that accepts walk-ins, including existing patients," he said. "Practices can incur fines of up to $10,000 per day for not complying with this regulation."

In addition to Perling, speakers for the webinar include Attorney Alan Gassman of Clearwater, Fla.-based Gassman, Bates & Associates, P.A., and Dr. Pariksith Singh.

Gassman is a board-certified estate planning lawyer who assists physicians, primarily on the west coast of Florida, with their practices and personal estate planning needs. In practice for 27 years, Gassman is a frequent author and speaker on topics related to asset protection and tax planning.

The immediate past chair of the Florida Bar's Health Law Section, Perling is a board-certified health law attorney, member of The Joint Commission's Home Care Professional and Technical Advisory Committee (PTAC), and author of the Medicare Claims Appeals Process Handbook.

Board-certified physician Dr. Singh is the CEO of Access Health Care, LLC, a multi-specialty group of approximately 85 providers in Florida, and CEO of Access 2 Health Care, LLC, an IPA that manages more than 15,000 managed care lives in Florida.

Source:
Broad and Cassel