7 Benefits of HIPAA 5010

By Tom Sullivan
09:03 AM

Although HIPAA 5010 essentially serves as the EDI pre-cursor to ICD-10, the new transaction standard also brings a fistful of its own noteworthy advantages.

Let's face it: HIPAA 4010 is outdated; hence the more than 500 changes in the pending 5010. What's more, HIPAA 5010 will “offer consistency of processing for payers and clearinghouses,” that 4010 does not, according to Christine Stahlecker, CMS director of medical billing procedures.

[Related: Top 5 HIPAA 5010, ICD-10 hurdles. See also: CMS 9 benefits of ICD-10.]

CMS, The centers for Medicare and Medicaid Services, in a National Provider Conference call last week outlined seven of the benefits above and beyond that processing consistency foundation. And, so, here they are:

  1. Less ambiguity in the implementation guides
  2. Enhanced usability and usefulness of certain transactions such as referrals and authorizations (X12 and NCPDP)
  3. Improved utility of the NCPDP standards, compliance with Part D requirements
  4. Supports standardization of companion guides across the industry
  5. Supports increased use of EDI between covered entities
  6. Supports e-health initiatives now and in the future
  7. Provides infrastructure on ICD-10 and Present on Admission Indicator

Stahlecker added that to make the transition as seamless as possible, healthcare organizations, if they've not already, should soon check in with their vendors to see when the system upgrades will be available.

Even the major software vendors are running late with both HIPAA 5010 and ICD-10 updates, and according to HIMSS most recent readiness survey, only 12 percent of providers have formally begun their HIPAA 5010 projects. All that may become problematic as the Level 1 compliance deadline of January 1, 2011 and the ultimate deadline of one year after that, to the day, draw closer.

“The timeline really brings it home to roost,” Stahlecker added.

For those healthcare organizations that have still not begun, HIMSS has outlined 8 steps for starting the HIPAA 5010 migration.


Tom Sullivan blogs regularly at ICD10Watch.com.