HIPAA Medical Billing – 5010 and ICD-10

The Health Insurance Portability and Accountability Act (HIPAA) establishes national standards for electronic health care transactions.  HIPAA was enacted to establish standards for moving away from paper medical records and transactions to electronic medical transactions.  The Act also places an increased emphasis on the security and privacy of health data.

HIPAA was enacted by the U.S. Congress and signed into law by President Bill Clinton in 1996.  Title I of HIPAA protects health care insurance coverage for workers and their families if they lose or change their jobs.  Title II of the Act mandates the establishment of national standards for electronic health care transactions.  Issues around the security and privacy of health data are also covered in HIPAA’s Title II.  The Act encourages the widespread use of electronic data interchange (EDI) throughout the U.S. health care system.

Most of the current conversation regarding HIPAA relates to the upcoming requirement for health care providers, clearing houses and health plans to comply with the new 5010 electronic transactions standards.  These new standards are required in order to improve upon today's 4010 electronic transactions standards which are unable to handle certain HIPAA Title II requirements.  In order for the U.S. health care system to meet the HIPAA mandates, a change in the electronic transactions standard format must be made.  5010 is that change.

Iridium Suite medical billing software is ready for the sweeping 5010 changes and therefore our customers are ready as well.  All electronic billing and inquiry transactions follow the new 5010 format as of January 1, 2012.  Iridium Suite will be compliant with 5010 and perhaps most important, the 5010 upgrade will be provided to our customers at no charge.  To learn more about Iridium Suite and 5010, click here or call us at 775-453-3193.

Another recent area of interest as it regards HIPAA, is the change from ICD-9 medical diagnostic codes to ICD-10 diagnostic codes.  The current ICD-9 diagnostic codes will be entirely replaced by new ICD-10 diagnostic codes on October 1, 2014.  The new ICD-10 codes will be up to 7 alphanumeric characters in length as compared to ICD-9 codes’ maximum length of 5 alphanumeric characters.  The codes have been entirely changed to allow for greater specificity for medical tracking purposes as well as improved accuracy in provider reimbursement.

Iridium Suite will begin transmitting the new ICD-10 codes, as mandated, on October 1, 2014.  Our IT staff will make all the necessary changes to our software so that each of our customers will be ICD-10 compliant on that date.  The ICD-10 upgrade will be provided to our clients at no additional charge.  This represents a huge savings compared to many other software providers who will charge for this upgrade.  To read more about ICD-10 click here or call 775-453-3193.