Is Your Hospice Agency 5010 Compliant? Now Is the Time to Check

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By Terry Miller, RN 
Regulatory Analyst, McKesson

Health & SafetyYou likely are aware that Center for Medicare & Medicaid Services (CMS) has delayed enforcement of the updated HIPAA 5010 transaction standard an additional three months, to June 30, 2012. But is your hospice agency ready now?

Since CMS already has delayed enforcement twice, it’s unlikely the organization will extend the deadline a third time. If you haven’t already, now is the time to check in with your payers to make sure that your electronic exchanges are compliant. Those transactions include claims and encounter information, payment and remittance advice, claims status, eligibility, enrollment and disenrollment, referrals and authorizations, coordination of benefits and premium payment. The 5010 standard paves the way for the move to the ICD-10 code sets, the implementation of which has also been delayed.

To help your hospice agency make sure it’s ready by July 1, CMS has improved and updated many of its 5010 resources:

  • Updated FAQs: There are three ways to access 5010 FAQs. All start by clicking on the CMS FAQs Page. Click on the topic HIPAA Administrative Simplification on the left side of the page, then click on subtopic Versions 5010 and D.0. The second way is to click the topic Coding on the left side, then subtopic ICD-10. Finally, you can search for “Version 5010” in the Search box on the upper left side of the page.
  • Fact Sheets: Download PDFs of background information and updates by clicking on the  Version 5010 page of the ICD-10 website.
  • Version 5010 Testing Readiness Fact Sheet: This PDF explains the 5010 upgrade and Phase I Internal and Phase II External testing that must take place. Learn the steps to complete testing for 5010 here.
  • ICD-10 website: Look here for the latest news and resources to help your transition to 5010.

The transition to the 5010 transaction standard is just one of many changes that will take place in the next few years. If your hospice agency is currently behind, learn from this experience and vow to start earlier on the other initiatives the home health and hospice industry will be facing.

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