JACKSON, Mich.--(BUSINESS WIRE)-- In just under five weeks, on January 1, 2012, physicians, hospitals, health plans and claims clearinghouses will be required to be in compliance with the ASC X12 Version 5010 HIPAA standard for the electronic transmission of healthcare claims and other administrative communications such as claims, remittance, eligibility, claims status requests and responses.
Evidence from the field and the efforts of organized medicine have persuaded the Centers for Medicare and Medicaid Services (CMS) that many providers and payers will not be ready to change from Version 4010 to Version 5010 by the January 1st deadline. On November 17th, CMS announced that it would delay enforcement for 90 days, i.e., through March 31, 2012.
If, after January 1st, an anesthesiologist submits a 4010 claim which the health plan rejects because it is running Version 5010 and does not accept legacy claims – or if the anesthesiologist is the one running Version 5010 and the health plan is not ready for that standard – the anesthesiologist has the option of filing a complaint (via the Administrative Simplification Enforcement Tool at https://htct.hhs.gov/aset). Any fine that CMS decides to impose on the health plan will probably not be issued for several months. The anesthesiologist in this situation should direct his or her efforts toward the health plan to determine how to get paid as quickly as possible.
When it announced the delay in enforcement, CMS urged physicians and other stakeholders to "continue working with their trading partners to become compliant with the new HIPAA standards, and to determine their readiness to accept the new standards as of January 1, 2012." Anesthesia and pain medicine practices that have not already assured themselves that their billing systems, their clearinghouses and their payers are ready to switch to Version 5010 should continue testing – or pushing their trading partners to test – on the assumption that there will be no further delays.
ABC has successfully tested Version 5010 transactions with all Medicare carriers and completed testing with all the private payers with whom our clients do business by the end of the year. We hope that the transition will be smooth and uneventful for all our readers.
For a better understanding of the three specific changes in Version 5010 that anesthesia practices need to understand, as well as a full discussion on Version 5010, please review here: http://www.anesthesiallc.com/publications/ealerts/296-anesthesia-and-the-version-5010-standard.
About Anesthesia Business Consultants
ABC, established in 1979, is one of the largest billing and practice management companies dedicated to the complex and intricate specialty of anesthesia and pain management. It is both an American Society of Anesthesiologists Practice Management Supporter, and an Anesthesia Quality Institute Preferred Vendor. ABC employs industry leaders, operates under proven efficient processes, and utilizes technology advances to easily adapt to the ever-changing regulatory environment.
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Anesthesia Business Consultants
Tony Mira, 517-787-6440
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