Electronic Transmission Standards Essay

1188 words - 5 pages

Electronic Transaction Standards
The protocols for sending and receiving ‘private’ information over the internet are ever changing. In the healthcare industry, particularly, privacy is a key issue. The Health Insurance Portability and Accountability Act of 1996 (HIPPA), requires the Department of Health and Human Resources (HH S) to adopt standards that must be used when conducting certain health care administrative transactions electronically, such as insurance claims and responses (Centers for Medicaid and Medicare Services [CMS]). The current version 4010 lacks certain functionality required by the healthcare industry, and just like other software programs, has become outdated. Because the 4010 version of the transactions is named in a federal rule, the regulatory process must be followed to upgrade to the 5010 version (American Medical Association [AMA] 2011}. New standards have been prepared to allow for continuing electronic transaction submissions by providers. HIPPA mandated that the health care industry use standard formats for electronic claims and claims-related transactions (CMS). The Final Rule was published on January 16, 2009 and makes the version 5010 transactions mandatory on January 1, 2012 (AMA). The International Classification of Diseases, Tenth Revision (ICD-10) was developed and is maintained by the World Health Organization (WHO) and is updated annually (CMS). In order to process transactions using the new ICD-10 code sets, version 5010 software must be in use. The final Rule adopting ICD-10 as the new code set has also been issued and is mandatory as of October 1, 2013 (AMA). Over 99 percent of Medicare Part A and 96 Percent of Medicare Part B claims transactions are received electronically (CMS). The Administrative Simplification Act of 2001 (ASCA) required the use of electronic claims for providers to receive Medicare reimbursement after October 16, 2003 (CMS). All organizations must be in compliance with updating to version 5010 before the transition to ICD-10 can begin because version 4010 is not compatible with ICD-10.
As with any new technology, system, or program, organizations should expect productivity losses, informational issues, large investments in education, and operational issues. Many of the same strategic and tactical planning activities for ICD-10 should be applied to version 5010 implementation (Health Information Managements Systems [HiMSS]). Providers, such as physicians, alternate site providers, rehabilitation clinics, and hospitals, health plans, healthcare clearing houses and business associates that use the affected transactions, such as billing/service agents and vendors are all HIPPA covered entities affected by the transition to version 5010 (CMS). The implementation of HIPPA version 5010 presents substantial changes in the content of the data that providers submit with their claims, as well as the data available to them in response to their electronic...

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