Will Your Billing Software Work With HIPAA 5010?

Many of us recently updated our billing software to meet the requirements of the HIPAA 5010 standards that will be required in a few short days. If you don’t update your software every year, you may be in for a big surprise. It’s not that the changes were so big that things are a lot different. It’s the conversion.

First of all I want to mention that there are many many billers who do not understand how the 5010 implementation affects them and are not prepared. We actually talked to one owner of a billing service very recently who thought that 5010 was code for ICD10 and it didn’t really affect him, just the people who did the coding. Let me repeat – your software must be capable of submitting your claims in 5010 format. I know it sounds technical but it’s important. Ask your vendors if you are not sure.

Not only does your software need to be capable of the 5010 format, but the clearing house you use must be capable of using it too. We also have heard that many clearinghouses have told billing services that they do not need to be updated but that they will convert the data to 5010 for them. To these people we just want to warn them that this may not work. We have been told that the billers themselves MUST also be compliant. We are actually curious to see who is correct. But if you are one of those people relying on the clearing house to convert your data for you, you should have a back up plan in case it doesn’t work. OK – enough on being ready for implementation which by the way, enforcement is now delayed 3 months. Let’s get back to what happens to the billing software.

What happens depends greatly on how many versions you are updating. For example, if you haven’t updated in several years and there are multiple versions in between your current version and the one you are updating to, you will experience more issues than someone who updates regularly. If you do regular updates, the issues will be fewer. One issue that you experience when updating is loss of production time. If you are fortunate enough to be able to have the actual conversion done during down time (when the office is closed or after hours) then you are lucky. Most have to do it during office hours and it eats up regular production time. If you are a billing service and you have employees this really can be a huge problem. You will want to have other jobs that your staff can be doing during the upgrade.

Also, you will have to do a little maintenance once the update is installed. Making sure the data converted properly, and that all the correct data is in the correct locations. The new version may require that you input required data into new fields. In any case, this maintenance will take time and usually will delay the billing a little longer. If you are updating multiple versions the data may not convert easily. You may have to have someone convert the data for you. Make sure all of this is taken into consideration before the conversion. You don’t want to have the update installed only to find out you have to come up with a way to convert your data.

Another problem you may encounter is a learning curve with the newer version. Usually software doesn’t change a lot from one version to the next but again it will depend on how many versions you are going up. One version to the next may not have that many changes, but going up multiple versions can result in a lot of changes. Sometimes even just one update can result in enough differences that it is like learning a new software. This issue can be big if you have multiple employees and you have to teach them the new changes as well.

New upgrades may also mess with your clearing house. If you use an outside clearinghouse, or one not directly connected with your software you may have to contact them to have changes made on their end as well. If you try to just submit claims using the old format but created on the new system they are not compatible with the clearinghouse any longer. They may need to schedule an installation so you should contact them prior to your upgrade to find out. You don’t want to wait for the upgrade and then find out they are booking installations three weeks out.

Many times people don’t take all things into consideration when preparing for an upgrade and they are broadsided by all of the issues that come along. If you think things out ahead and do your homework, you can eliminate some of the stress that comes with the conversion. No conversion is ever stress free (or problem free) but preparing yourself as much as possible is the best way to reduce the issues.


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