Chiropractors Must Get Ready for HIPAA 5010 or Expect No Pay in 2012

DC's still have time to convert to the new HIPAA 5010 format for electronic claims submission. End Quote

(1888PressRelease) April 28, 2011 - Chiropractors who utilize electronic billing must convert to the new HIPAA 5010 format by January 1, 2012 or risk not being paid by all third party payers, including Medicare.

In spite of the potentially disastrous financial consequences that may occur if a practice is not prepared, most chiropractors have not even started to test their compliance with the new, mandatory format. Apparently, chiropractors are not the only healthcare practitioners who think that 2012 sounds like a long way away. The Medical Group Management Association released a survey of over 13,000 M.D. practices in March that revealed that 61% of medical practices have yet to schedule any testing with the health insurance plans that will pay them.

The rule changing to the HIPAA 5010 format for electronic claims submission was passed back in 2009 due to the fact that the current version of 4010 data was admittedly lacking. The migration to the HIPAA 5010 format is also the pre-cursor to the ICD-10 diagnosis code set that is scheduled for adoption in 2014.

"Chiropractors should not confuse the two upcoming changes and delay the implementation of their HIPAA 5010 conversion," warns Tom Necela, DC, president of The Strategic Chiropractor and a consultant to the chiropractic profession who is also a Certified Professional Coder and Certified Compliance Professional. "The HIPAA 5010 conversion needs to be implemented, tested and ready as long before the January 2012 deadline. Although it will ultimately interface with ICD-10, they are independent of each other. As such, chiropractors cannot afford to wait to start using both new data standards simultaneously else they will risk not getting electronic payments from payers."

Fortunately, chiropractors are not in trouble yet if they haven't started the 5010 conversion. Most payers have recently completed error testing the new data set and now is an ideal time for practices to begin their own testing of the new 5010 format.

When asked why chiropractors (and physicians at large) were not yet getting ready for 5010, Dr. Tom Necela offered two possible reasons:

"The first is just a general lack of awareness," Necela states. "With all the regulatory changes that have taken place over the last couple years, the $44,000 EMR stimulus and the demands of daily practice, it is tough for all physicians to keep up with new requirements. Consequently, some chiropractors don't even know this is a requirement and perhaps won't, until it's too late."

The second possible reason cited by Dr. Necela is prioritization. "Even if chirorpractors are vaguely aware of the need to change to HIPAA 5010" Necela reasons, "there is a good chance that they may not fully understand it or give it the priority that it demands. For example, there are chiropractors scrambling like mad to potentially qualify for the $44,000 stimulus package, which they may or may not achieve. On the other hand, if they are not converted to 5010 standards by the deadline, there are definite - not potential - consequences: you won't be paid. So to me that's a higher priority item."

While the level of preparation required for each chiropractic office may vary on its size, percentage of claims transmitted electronically and number of payers to whom they submit claims, most experts in the healthcare billing and compliance industries agree that businesses that adopt early implementation of these new standards will be most likely to succeed.

Experts also agree that it's not too early (or too late) to get ready for the January 1, 2012 deadline. Although all parties involved - physicians, their practice management software vendors, electronic claims clearinghouses and the payers themselves - will need to convert to the 5010 format, ultimately each chiropractor has the responsibility to prepare his or her practice for the transition.

Although the process may be daunting, by getting started today on implementing the 5010 transactions, chiropractors can ensure that they meet the January 1, 2012 deadline and do not suffer claim payment interruptions.

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