HIPAA 5010 Implementation: Timeline, Levels and Testing Readiness

It has been eight years since the HIPAA 4010 transaction standards were implemented in 2003. Since then, the industry has asked for more than 500 changes to correct errors and fulfill new requirements. The new regulations are a systematic approach to reform the health system with a pristine timeline. The regulations were introduced in 2009 and by January 1, 2012, all covered entities are required to submit claims, remittances, status responses and referral authorizations meeting 5010 standards.

The Centers for Medicare & Medicaid Services (CMS) identified two levels of HIPAA 5010 testing:

Level I of 5010 implementation ended on December 31, 2010. It is labeled as internal testing which covers gap analysis, design, development, etc.

Level II of 5010 implementation dates December 31, 2011. After that, only 5010 compliant systems are allowed to work.
All covered entities are required to integrate ICD‐10 coding system by October 1, 2013.

Is your organization ready to demonstrate error free flow of healthcare data? As the deadline to meet the second level of HIPAA 5010 electronic transactions standards is fast approaching, if you find yourself completely lost in the testing process for HIPAA 5010 compliance, then The American Medical Association (AMA) has formulated guidelines to test your readiness. Another suggestion is to hire a consultant.

HIPAA 5010 transactions compliance is applicable to covered entities that are healthcare providers, payers of the health cost, clearinghouses and pharmacies. To be perfectly compliant, all the stakeholders require working on different areas outlined below:

HIPAA Administrative Requirements: At the administrative level, the covered entity should analyze possible violations of HIPAA regulations and plan to eradicate them. For instance, access to patient’s health information by an employee should be under strict scrutiny. As soon as the employee leaves the organization, the access to information is barred. Exchange of information with partner organizations should be well defined and with the exchange of a signed agreement. Make sure that every employee is properly trained about security and privacy of the data. They must use passwords to login and report efficiently in case of a security breach or data loss. In case of an emergency, there should be a backup of data that can be restored later.

HIPAA Physical Requirements: Ensure the physical safety of those within the facility through locked doors, security cameras and human surveillance. Access to a room or department should be role defined. Design policies and plans for repairs and modifications. Proper measures should be followed to dispose data.

HIPAA Technical Requirements: Every user should be provided with a unique identity. Similarly, implement procedures to share information during emergencies. An EHR system should demonstrate the capability of automatic logoff if not used for a specific period of time. Moreover, data should be encrypted before sending to another network. Preventive measures should be strictly followed to establish integrity of health information that could secure it from possible damage.

Due to an impending deadline of the HIPAA 5010 compliance, it is time to hit the nail on the head. Test your EHR system and resolve any issues that occur in a timely fashion, before it is too late. Send test transactions to outer entities (clearing houses, billing companies) and check if they are also complying with the standards. If your system were able to send and receive transactions in compliance with HIPAA 5010 transactions standards, only then would it be considered operational and standardized.