Healthcare providers may need HIPAA compliance backup plan

The Healthcare Information and Management Systems Society (HIMSS) released a letter on September 19 that featured advice for small and large healthcare providers that aren’t on track to comply with the HIPAA 5010 electronic transaction standards. The deadline for the transition is scheduled for January 1, 2012, and as a result, doctors and physicians who may not meet the deadline need to put in place provisions to mitigate any difficulties that may arise.

Research by the organization suggests this could apply to as much as 33 percent of all providers, based on a 2011 survey that the institution conducted.

According to InformationWeek, which obtained a copy of the correspondence, the HIMSS says many clinicians won’t be able to conduct claims, referral authorizations or other essential tasks with the upgraded version of the technology by the deadline.

“Without these pre-agreed contingency plans with their trading partners, providers may experience rejections resulting in delayed or non-payment for non-compliant claims,” said Juliet Santos, the senior director of HIMSS business-centered systems, in the letter, according to the news provider.

HIMSS is advising doctors and facilities in this position to develop contingency measures so that their business operations aren’t substantially affected. Provided that this time and energy isn’t put into ensuring a smooth compliance with the latest HIPAA regulations, facilities may not be able to process payments. This could cause an organization’s cash flow to stop and even necessitate that the facility shuts down in severe circumstances.

If the process isn’t completed by the scheduled date, facilities may need to communicate more frequently with different providers, vendors and payers. However, it is possible to submit 5010 transactions using the older system, 4010, the news source indicates.

Facilities that are facing difficulties may want to consider working with a company that can provide guidance, support and installation. This can help when the next major transition – whether it’s for the medical billing software or NPI compliance process – and connect them with valuable vendors such as Medisoft, Lytec and Practice Choice.