HIPAA 5010 DefinitionHIPAA 5010 Definition and Its Place in HITECH  

A HIPAA 5010 definition is best provided by explaining the term itself.  The Health Insurance Portability and Accountability Act of 1996 was enacted by U.S. Congress on 21st August, 1996.  It was signed by President Bill Clinton and was designed to protect the health insurance of workers and their families in the event of them losing or changing their jobs. It also required national standards to be established for the electronic transaction of health care transactions and improvements in the security of such records.

Implemented in 2002, the version of HIPAA used until January 1st, 2012, was known as HIPAA 4010 (Version 004010 of the Accredited Standards Committee (ASC) X12 Technical Reports Type 3). This version regulated the electronic transmission of specific medical and health data such as claims, payments, referrals, health plan enrollment details, eligibility and more.

HIPAA 5010 Definition: Benefits  

There are several reasons why Version 005010 (HIPAA 5010) was deemed necessary, though fundamentally, 4010 was outdated and need brought into the second decade of the 21st century. Electronic communication of health care information was difficult to communicate confidentially, and the HIPAA 5010 would facilitate this, enabling easier and more consistent transmission.

There were other benefits, such as a lack of ambiguity, more consistency and the ability to make greater use of such records to the benefit of both the patient and the health care authorities. Other shortcomings were that HIPAA 4010 could not support the reporting of NPI (National Provider Identifiers) and was unable to support the new ICD-10 codes planned to supersede the ICD-9 codes in 2013. There was also a great of redundancy contained within the 4010 regulations.

HIPAA 5010 was originally planned to be in full use on January 1st, 2012, but it has been proved too difficult for many HIPAA covered entities to meet this deadline. Whether due to difficulty or apathy is irrelevant, but since only around 4.5% of covered entities estimated that they would be ready by that date, an extension to March 31st, 2012 has been applied for sanctions for non-compliance.

What this means is that HIPAA 5010 should still be applied from 1 at January, 2012, but that any complaints made after then will not be followed up if the your resolve the complaint satisfactorily or can demonstrate that you are actively doing your best to comply as quickly as possible. Meantime, HIPAA 4010 transactions will be accepted, but only if you are working hard to comply, and then only until March 31st, 2012.

HIPAA 5010 Definition: Trading Partners and Vendors 

You should by now be carrying out end-to-end testing with your trading partners, and have made sure that the software of any third-party hosting service has been updated. If not, then you should get cracking with these immediately. You should also be making sure that everybody involved with ICD codes are refreshing or improving their knowledge of fundamental physiology, anatomy and the medical terminology needed in applying the codes.

It is also important to check with your vendors that they are also getting ready to comply with HIPAA 5010 and any other aspects of HITECH. It should be made clear that your paper transactions will not change:  they are not covered by HIPAA 5010 which is only concerned with electronic transmission (emails, downloads, PDF formats, etc).

HITECH extends the security provisions of HIPAA to the business associates of covered entities, so make sure that your businesses associates are also preparing for HIPAA 5010. Business associates include all who are part of a BAA agreement, or who may come into contact with private health information (PHI) either directly or otherwise. HITECH took effect at the end of November, 2009, so such associates should already be ready for HIPAA 5010 compliance.

HIPAA 5010 Definition: ICD Codes  

A significant feature of Version 005010 is the switch from ICD-9 codes to ICD-10 codes on 1st October, 2013. This is a significant change, and the reason for the medical terminology training mentioned briefly above. These transitions are being made to update the codes, and new list will be around ten times the length of the old ICD-9 list with no general 1:1 equivalence.

Basically, ICD-9-CM clinical modification codes with be replaced by the new extended ICD-10-CM medical diagnosis codes, while the Volume 3 codes of ICD-9-CM covering inpatient procedures will be replaced by the new ICD-10-PCS codes. These do not affect outpatient procedures that will still employ the CPT (current procedural terminology) codes.

Although these codes do not come into effect until 1st October 2013, there is a lot of work and education involved in understanding and using them, so you should be planning now to commence training and education if these affect you.

HIPAA 5010 Definition: Conclusion 

HIPAA 5010 is a sensible and logical evolution of HIPAA 4010, and not only streamlines the handling of electronic health data but also paves the way to a more discerning range of medical codes for procedures and diagnosis of medical conditions. Health care professionals, including IT professionals, must adapt to the new regulations, and while the 3-month extension is welcome to many, it is not an extension of compliance, just of sanctions for a failure to comply.

If you are a covered entity under HIPAA, then this HIPAA 5010 definition makes it clear that you should be actively trying hard to join the 4.5% that are in compliance, and not wait until the last day. You should also have ICD-10 in mind when doing that.

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