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HIPAA 5010: A Year in Review


HealthMEDX HIPAA 5010By: Don Carlson, Senior Development Manager, HealthMEDX, LLC

The HealthMEDX HIPAA 5010 team has been working on the 5010 project for a little over a year.  Since late Spring 2011, development efforts really gained momentum. 

In addition to HealthMEDX efforts, clients have made significant progress with 5010 preparation and testing.  Clients began reported their first 5010 production approval in August of 2011 and the first MAC blanket vendor approval was received in September of 2011.  Since the inception of the project, the HealthMEDX team has identified, and are tracking, just over 300 client lines of business for 5010 claim format upgrades.  Currently, over 85% of Medicare lines of business have passed testing and/or are getting 5010 claims paid in production within the HealthMEDX client base.  In addition, client Medicaid lines of business have over 60% within that same status!

In late December, 2011, Medicare announced a 90 day discretionary period where they would not force the use of 5010 claim formats until March 30th, 2012.  Before that deadline, Medicare extended another 90 days through the month of June.

Despite the extension of the discretionary period by Medicare, HealthMEDX clients have been exceptional in preparing for the upcoming regulatory change.  To move 100% of HealthMEDX clients to a completed testing status and move them into production with the 5010 claim format,  there is still some work to do.  It might be a natural reaction to relax 5010 testing efforts during this extended discretionary period, but HealthMEDX is driving the continued assistance of clients in their efforts to complete this testing now. 

With over 75% of HealthMEDX clients already prepared for the HIPAA 5010 change, clients are making significant strides to be ready for the 5010 transition. 




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