Are You Ready for HIPAA 5010?

On January 1, 2012, covered entities will be required to conduct the current HIPAA electronic transactions using the upgraded 5010 version.  Such transactions include claims submission, remittance advice, eligibility, claims status, referral authorizations, and others.

In order to successfully implement the 5010 transactions, covered entities should take the following steps if they have not already been completed.  This will help to avoid rejected claims and cash flow interruptions.

1. Review the details involved in the upgrade and assess the impact the change to HIPAA 5010 will have on your business operations and systems.

2. Contact your vendors for specific information regarding the installation of upgrades to your system. Also, contact your clearinghouses, billing service, and payers for preliminary information on when they expect their upgrades will be completed and they will be ready to accept the 5010 transactions.

3. Have your vendor install the necessary 5010 upgrades. Remember that the timing of the system upgrades will depend on your vendor’s readiness, both with respect to product development and scheduling.

4. Once the upgrades are completed, internally test your systems to make sure you can generate the 5010 transactions. Allow extra time to resolve any issues that may arise and work with your vendor to address these.  It is important to make sure that staff members are properly trained on the 5010 transactions as part of this process.

5. Contact your clearinghouses, billing service, and payers to conduct external testing with them. This will help to ensure that you can send and receive the transactions properly.

6. After you have completed external testing, you may switch to using only the 5010 transactions. You are permitted to begin using the 5010 transactions prior to the compliance date, as long as you and the other organization are in agreement with the early conversion.

Important Dates to Keep in Mind:

January 1, 2012 – Covered entities must use only 5010 transactions as of this date.  The 4010 transactions will be rejected.

January 1, 2012 to March 31, 2012 – The first 90 days is a period of discretionary enforcement.  A covered entity generally will not receive penalties for failing to comply with HIPAA 5010 as long as it is making reasonable efforts to follow the requirements.

October 1, 2013 – The industry switches from the ICD-9 to the ICD-10 diagnosis and procedure code sets.

© 2011 Parsonage Vandenack Williams LLC

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Five Ways to Use Social Media in Your Practice

Here are five simple ways to use social media to help your practice:

  1. Develop your social media pages.  Consider starting a page for your practice on Facebook, LinkedIn, and/or Twitter.  Persuade your patients to “like” your practice’s Facebook page – your postings will then be featured in their news feeds.
  2. Send health-related updates.  Send e-newsletters with short reminders or news stories of interest to your patient population.  Patients will appreciate brief tips provided at no cost.
  3.  Take advantage of online networking.  Many people meet potential employers and employees on career-centered social networking sites such as LinkedIn.   Join a discussion group with similar interests and goals.
  4.  Launch a blog.  A blog is an efficient way to provide information to your patients and the online community and another way to promote your practice. 
  5.  Post general information.  Tell us about who you are and what your practice does.

Remember to always use caution and comply with all applicable privacy and confidentiality rules when using social media sites, as well as any other media outlet.

© 2011 Parsonage Vandenack Williams LLC

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Stop and Think Before Using Groupon to Promote Physician Services

The internet has vastly improved our ability to find great bargains.  Many people subscribe to sites like Groupon, Living Social, and others that offer discount goods and services. Over the past several years, there has been a notable rise in the number of promotions related to cosmetic services and products.

Is this a good thing for health care providers?

Before a physician or other health care provider decides to offer a Groupon special, you must consider the federal and state rules and regulations governing physician practices, marketing and referrals.  Internet deals are NO exception to the rules.

It is important to think about the following when entertaining the thought of online marketing: 

  • Fee-splitting: Fee-splitting laws vary by state, but most states do not allow licensed physicians to divide physician revenue in exchange for referrals. Physician revenue is typically revenue from services that can only be sold by a licensed physician. Most social media sites charge a percentage of the income generated on each “deal” that is sold. The sites may accept the payment from the patient rather than the physician, but the fee still represents a portion of the fee that the physician would have generated for his or her “professional” service.
  • Anti-Kickback Statute: The federal Anti-Kickback statute prohibits the payment of remuneration, or “kickbacks”, in exchange for referrals.  This includes both direct and indirect remuneration. 

Most of the services sold on Groupon are not covered by Medicare, so the Anti-Kickback statute would not apply in such instances.  Still, many states have similar statutes that apply to situations where other insurance or out-of-pocket payments are involved.  Nebraska does not have an Anti-Kickback statute that mirrors the federal statute.

Currently, there is no formal AMA opinion, case law, or other guidance on these issues.  The use of social media sites for promoting one’s practice may be a great tool in an era of technology, but proceed with caution and make sure to comply with all applicable laws before launching any web-based discounts.

© 2011 Parsonage Vandenack Williams LLC

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Website Provides Physician Certification Information

The American Board of Medical Specialties (“ABMS”) now publicly reports whether specialists are meeting the continuing education requirements necessary for maintaining board certification.  The following member boards are the first boards to report via the ABMS:

  • Dermatology
  • Family Medicine
  • Nuclear Medicine
  • Otolaryngology
  • Physical Medicine and Rehabilitation
  • Plastic Surgery
  • Surgery

Information regarding physicians certified by the above boards can be found at: Search results reveal the name of the certifying board, and a “yes” or “no” regarding whether the physician meets the maintenance of certification (“MOC”) requirements for such board.

Maintenance of certification status will be available via the ABMS for the remaining American Board specialties by August 2012.

© 2011 Parsonage Vandenack Williams LLC

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E-Prescribing Significant Hardship Exemption Deadline is November 1

Just a reminder that the deadline for requesting significant hardship exemptions under the Medicare electronic prescribing (“eRx”) incentive program is November 1, 2011

Starting in 2012, eligible professionals who are not successful electronic prescribers under the eRx incentive program will be subject to a payment adjustment. The final rule incorporates four additional hardship exemptions for purposes of the 2012 payment adjustment, including the following exemptions:

  • Registration to participate in the Medicare or Medicaid EHR incentive programs and adoption of certified EHR technology.
  • Inability to electronically prescribe due to local, state or federal law or regulation
  • Limited prescribing activity.
  • Insufficient opportunities to report the electronic prescribing measure.

The exemption requests must be made using a web-based tool available on the eRx incentive program website at

© 2011 Parsonage Vandenack Williams LLC

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New Program Changes the Way Medicare Reimburses Health Care Providers

A pilot program called the Bundled Payments for Care Improvement Initiative (the “Bundling Initiative”) has recently been unveiled by The Department of Health and Human Services (the “Department”).  The program is designed to change the way Medicare reimburses health care providers. 

Under the current method, Medicare makes separate payments to each provider. In an effort to encourage better coordinated care and decreased costs, the Bundling Initiative calls for Medicare to pay one lump sum to the hospital for an “episode”, such as a hip replacement or heart bypass surgery, and the hospital would then distribute the payment to participating providers.  The concept is that if Medicare pays only one large payment, the individual providers will communicate with each other to promote efficient and high quality care.  Obviously, the Department is ignoring the possibilities of abuse by some providers, especially the recipient provider.

The Bundling Initiative is seeking applications for four defined models of care.  Three of the models involve retrospective bundled payments, and one model would pay providers prospectively.  Interested providers must submit a nonbinding letter of intent to the Department by September 22, 2011 for Model 1 and November 4, 2011 for Models 2-4. 

© 2011 Parsonage Vandenack Williams LLC

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Ambulatory Surgery Centers (‘ASC’s”) may be required to notify patients of their rights and of the facility’s ownership before the day of surgery under a rule be considered by the Department of Health and Human Services (“HHS”).  An exception would be made when the referring physician indicates that it is medically necessary for the patient to undergo surgery that day.

Other regulations undergoing review include the ASC rules related to the list of operating room emergency equipment required to be available and a duplicative infection control program requirement.

© 2011 Parsonage Vandenack Williams LLC

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HIPAA Business Associate Audits May Be On The Way

Business Associates (“BA’s”) may be audited, in addition to covered entities, in 2012 audits by the Office for Civil Rights (“OCR”).  OCR has a three step audit program in progress. If the initial program “goes well” (whatever that means), then OCR will implement a full range of onsite audits and an evaluation process. BA’s come into contact with significant amounts of protected health information.  Because approximately 20% of HIPAA breaches involve BA’s, consideration is being given to including BA’s as audit targets.

© 2011 Parsonage Vandenack Williams LLC

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Proposed Rule Gives Physicians a Break on Requirement to Electronically Submit Quality Measures

The Centers for Medicare and Medicaid Services (CMS) gave physicians a break (albeit brief) its recent proposed rule on meaningful use reporting requirements for electronic health records (EHRs).

The proposed rule would permit eligible providers to continue to report certified EHR clinical quality measure results by attestation through 2012. Absent the proposed rule’s enactment, EPs will need to submit quality measures electronically to CMS in 2012.

Note that eligible providers who are willing and able to submit clinical quality measures electronically in 2012 can maximize incentive payments and meet meaningful use requirements by participating in the newly-announced Physician Quality Reporting System-Medicare EHR Incentive Pilot.

Physicians who submit clinical quality measures for the entire year using one of the specified electronic options would be eligible for incentive payments from both the physician quality reporting system and the EHR programs.

Physicians who initially attest that they will participate in the Physician Quality Reporting System-Medicare EHR Incentive Pilot but are then unable to participate can still submit quality measures using the CMS attestation module.

© 2011 Parsonage Vandenack Williams LLC

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Reminder to Physicians: Meaningful Use Checks are Arriving

On May 19, the Centers for Medicare and Medicaid Services (“CMS”) mailed the first checks for the Medicare incentive program to physicians who had attested that they had achieved meaningful use of their electronic health records (EHRs).

EHR incentive payments are also available to eligible professionals from state Medicaid programs.  However, the Medicaid program has different incentive requirements.

The actual arrival of checks from Medicare should encourage more doctors to acquire EHRs and demonstrate meaningful use. The checks show that meaningful use and successful EHR implementation is certainly achievable.

Given EHR is going to be the standard of practice and physicians will eventually need to implement EHR systems, there is no better time than the present to get started.

We do not have our EHR incentive program outline on the PVWLaw website because we were only providing to clients.  I could do the same thing we did with some of the health care bill articles and state “PVWLaw has prepared a comprehensive outline on the EHR incentive programs called “EHR Incentive Program Outline”.  If you would like to receive a copy of the outline, please email the following information to and we will reply promptly including a pdf attachment of the document requested:

1.    Name of the document requested

2.    Your name

3.    Name of your company

4.    Your title

5.    City and State where your company primarily does business

Please note, requesting a document will add you to our email list. This means you will receive certain emails that we believe may be of interest to our clients and friends. To unsubscribe and stop receiving emails from us, please send an email to from the email address where you receive our emails.

© 2011 Parsonage Vandenack Williams LLC

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