TO: AMCO Providers
FROM: AMCO Network Services
RE: HIPPA - Implementation of 5010 and ICD-10
The next version of HIPAA Standards will soon go into effect and we want to make sure all our providers and office staffs are aware of the compliance date. Effective January 01, 2012, compliance with version 5010 transactions will go into effect and although some payers may have a grace period after January 1 effective date, the grace period may be very limited.
While there are several changes with this version 5010, the changes in the requirements for billing and remittance are very important and may require changes to information with payers.
- The use of the billing provider field has been clarified. In 5010, the billing provider must be a provider of health care services and can no longer be a billing service or clearinghouse.
- In 5010, the billing provider address must be a street address and can no longer be a PO Box or lock box. Physicians who want to have their payments sent to a different address will use the pay-to-provider name and address fields.
- The rules for reporting provider roles and the NPI have been more clearly defined.
There are also significant changes in the reporting of anesthesia minutes and could affect your reimbursements. In 4010 payers could require the anesthesia time reported as the total number of minutes or as units. In 5010, only the total number of minutes may be reported. Units are no longer an acceptable format for reporting anesthesia time.
If more information is needed or for offices that have not begun to prepare, please visit www.ama-assn.org/go/5010. This site will provide additional resources for implementing the HIPAA 5010 transactions and the fact sheets there are very informative.
Also keep in mind the compliance with ICD-10 code sets will go into effect October 01, 2013.
We hope this information and web links are helpful. WE appreciate your continued participation and support and will make every effort to keep you informed of changes as we receive them.
