How the 5010 Standard Will Affect Long Term Care Providers and Billing

As announced by the U.S. Department of Health and Human Services (HHS) on January 16, 2009, updated versions of the Health Insurance Portability and Accountability Act (HIPAA) transaction will be required to be used by providers beginning on January 1, 2012. The HIPPA standards for electronic health care transactions are changing from version 4010/4010A1 to version 5010. The Centers for Medicare and Medicaid Services (CMS) oversaw compliance with these standards and this is required by federal law.

The 5010 consists of a new set of standards regulating the electronic transmission of specific healthcare transactions. These transactions include claims, remittance advices, and requests and responses for eligibility and claims status. The 5010 transactions report electronic claims, electronic eligibility verification, electronic claim status, electronic referral certification and authorization, electronic remittance, and more. The 5010 standards will increase transaction consistency, support pay-for-performance, and streamline reimbursement transactions.

Those who are required to upgrade to the 5010 standard include a range of health care providers, including long-term care providers. In this regard, the implementation may change the software, systems and procedures already used for billing Medicare and other such payers. The 5010 will ensure that insurance companies receive accurate bills in the correct data and formats. LINTECH’s COMET application for long-term care billing is set to assure its users that their submissions will be in full compliance with the 5010 requirements.

Healthcare providers who fail to use only the 5010 transactions as of the January 1, 2012 deadline risk claim rejections and interrupted cash flow. Anyone who already electronically submits transactions, such as checking a patient’s eligibility, filing a claim, or receiving a remittance advice, will be automatically updated to the current version.