Is your practice prepared for the mandatory format conversion to HIPAA 5010?
Most chiropractors do not realize that if they submit claims electronically that we must convert to the 5010 Format by January 2012 or you will not be paid!
If 2012 sounds like a long way away, you should know that testing for the 5010 conversion started back in April 2011! Large entities in the medicine (such as hospitals and big group practices) actually began preparing for this change back in 2010.
Unfortunately, most chiropractors are not even aware that such a change is required.
What the 5010 Electronic Billing Format Conversion is All About
Specifically this format conversion is called 5010 and you might’ve heard of it as a HIPAA 5010 Format Conversion or “mandatory claims reformatting.” Lots of chiropractors have been emailing me for advice on what to do, where to go for information and what exactly is required for the conversion.
First — a reality check. Do NOT be fooled by the term HIPAA! One reason I told you up front that you will not be paid and I didn’t mention HIPAA is that I know chiropractors by in large ignore lots of things related to HIPAA. They think, “Well in I’ve never seen a HIPAA policeman” or “this is just some low priority compliance items I can handle later.” This is entirely different!
This 5010 conversion is mandatory if you do ANY sort of electronic claims transmission or electronic billing.
Whether it be through a clearinghouse, directly to the payers, using your EMR system or even if you use an outside biller – it doesn’t matter — you will have to utilize the 5010 Format by January 1, 2012 or, as I stated previously, you will not be paid!
Here’s the good news:
The process to convert to 5010 is not as daunting as it may sound. Rest easy, chiropractors, you won’t have to actually LEARN anything new! Think of the conversion more along the lines of a software upgrade rather than new tools you need to learn how to use.
And the Bad News
- Did I mention it’s mandatory?! So it’s not quite like upgrading to the latest version of your browser or some software. No choice here. No conversion, no get paid! And it’s got a deadline to boot.
- Everyone has to convert! Specifically, that means everyone using electronic claims submission in some form. So, yes, chiropractors too!
- Testing is necessary! True to government fashion, the initial beta-testing of the 5010 Format was riddled with errors — so it is recommended that you start the conversion process soon and test ASAP! Don’t delay or you may be forced to go “live” with an error-filled version of 5010!!
How to Go About It
- Get started researching and putting together the list of necessary resources, testing protocols and access points — SOON!
- Overwhelmed? You’re not alone. I’ll be holding a webinar to walk you through the ACTION STEPS you need to take to successfully prepare your office for the 5010 Format Conversion…so that you can be paid in 2012!
GET YOUR CHIROPRACTIC PRACTICE READY FOR 5010 Webinar!
In this 90 minute recorded webinar (sent to you on CD so you can watch it at your leisure), I will guide you through the challenges you’ll face and explain what you must do now to be ready, including:
- The business impact of 5010, including how it will revolutionize the way you verify patient eligibility and examine why claims were denied
- The latest changes to 5010 and CMS’s timeframe, including recent revisions and the key dates you must know and prepare for
- How to work with all payers, including Medicare, for a smooth transition to 5010
- The 277CA, the Functional Transaction 999 and other “need to know” items that will ensure your office will upgrade correctly
- Why you want to convert and test the 5010 Format as soon as possible — and what will happen to the procrastinators!
The transition to the HIPAA 5010 standard for electronic claims transfers in 2012 may seem far away, but you need t
o take advantage of the lead time now to avoid major A/R disruptions and ensure your claims will get paid properly on day one.
Don’t delay and risk not getting paid –buy