Version 5010 of HIPAA standards includes improvements in structural, technical, functional, and data content. It is more specific in extracting the data that is actually needed. The extracted data is collected and transmitted in a transaction incorporated with tightened security and clear situational rules. The implementation of HIPAA 5010 presents major and significant changes regarding the data content that an individual would need to submit along with his/her health claims including the data availability to an individual in response to his/her electronic inquiries. The implementation of HIPAA 5010 will require numerous modifications to be effected to the existing software, systems and procedures that are being used for Medical billing processes. Hence, it becomes extremely imprudent that the existing players in Healthcare domain are well-informed regarding the changes to be made effective in HIPAA and accordingly plan for its implementation. HIPAA 5010 version is able to distinguish and decipher between various terminologies being used such as principal diagnosis, admission diagnosis, external cause of injury, internal cause of injury, external precipitating factors, internal precipitating factors, and reason for patientís visit to an IPD/OPD for visit codes. On account of such distinctions being initiated in the healthcare database, it will improve the overall understanding of clinical data. It will result in facilitating better evaluation of mortality rates in human beings for certain illnesses, outcomes of specific treatments, duration of hospital stay for certain ailments, the reasons why hospital care for the patient is being sought. Finally, Version 5010 also addresses a variety of currently unmet business needs of an organization.
The ASCA (Administrative Simplification Act) makes it mandatory for the compulsory usage of online electronic claims except for a few cases so that the Healthcare service providers can receive their re-imbursements/payments accordingly. With effect from January 1, 2012, all healthcare organizations must be prepared to submit their claims online electronically by using X12 Version 5010 and NCPDP Version D.0 standards, which is a pre-requisite requirement for implementation of the latest ICD-10 codes. The Centers for Medicare & Medicaid Services (CMS) will provide additional assistance regarding HIPAA 5010, in case any problems are encountered. The X12 Version 5010 and Version D.0 standards, are national standards of HIPAA and apply to all healthcare transactions.
These current versions of HIPAA standards i.e. the Accredited Standards Committee X12 Version 4010/4010A1 for health care transactions including NCPDP Version 5.1 for pharmacy transactions have major drawbacks and lack in certain functionalities that is badly needed required by healthcare sector.
It is of utmost importance that healthcare service providers should be ready to incorporate and implement new HIPAA standards so that claims can be continued to be submitted online electronically, without any hassles.