Deciphering HIPAA 5010 Mandate

To ensure that the urgency of adopting HIPAA 5010 standards is understood by all covered entities, a compliance date has been set for all covered entities is January 1, 2012. However, small-scale health plans are exempted from this immediate date for graduating to HIPAA 5010 benchmarks. A relaxation had been for covered entities associated with smaller health plans where the compliance date has been extended until January 1, 2013. HIPAA 5010 is being looked upon as an effective solution for making transactions in the healthcare industry more uniform as submission of patient information to insurance carriers will be more regulated.

The HIPAA 5010 mandate stipulates that as on January 1, 2012 all covered entities should have attained Level 2 Compliance. This means that they should be fully compliant in their use of HIPAA Versions 5010 & D.0. So far, there have been no indications from the U.S. Department of Health and Human Services (the HHS) that it will authorize contingency plans for making HIPAA 5010 compliance faster. This is because any more urgency in upgrading to HIPAA 5010 standards might hamper the implementation of ICD-10 aspects such as calculating the correct effective date. However, HIPAA has given HHS the authority for invoking civil/monetary penalties against any covered entity who doesn’t comply with the HIPAA 5010 standards.

The HIPAA 5010 mandate is actually a part of a larger package of updates taken upon by the HHS which will also affect the Medicaid part of pharmacy claims—these changes are also being referred to as the NCPDP Version 3.0. However, for upgrading to Version D.0 also, the compliance date has been set at January 1, 2012. This has been done to allow the healthcare industry sufficient time for testing the HIPAA 5010 standards at an internal level, i.e. within their practices and content management systems. This will also ensure that all trading partners associated with covered entities can also understand the demands put forth by HIPAA 5010 before the compliance date. Version 5010 is a bit more comprehensive in terms of billing codes, i.e. more code sets of the ICD-10 have been put forth. This essentially means a small modification in the medical code sets used in the existing coding systems. This is being interpreted as expanding the span of hospital procedure coding.

The HIPAA 5010 adoption has been conceived in a more public format. For instance, a document titled 'Adjusted Costs and Benefits for Version 5010, D.0 and 3.0' has been published in an online (downloadable) format that helps covered entities to understand the financial impact on management and processing of healthcare information as per HIPAA 5010 mandate.