Electronic Transmission Standards

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4010 lacks certain functionality required by the healthcare industry, and just like other software programs, has become outdated.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 electron...

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References

American Medical Association. Version 5010 Electronic Administrative Transactions.

Retrieved September 26, 2011 from

http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-

billing-insurance/hippahealth-insurance-portability-accounting-act/transaction

American Medical Association. (September 9, 2011). Preparing for the Next Version of HIPPA Standards : January 1, 2012 Compliance Date. Retrieved September 29, 2011 from

http://www.ama-assn.org

Centers for Medicaid and Medicare Services. New Health Care Electronic Transactions Standards. Retrieved September 26, 2011 from

http://www.cms.gov/ICD10/Downloads/w5010BasicsFctSht.pdf

Johnson, K., MAEd, CHIM & Weirz, C., MBA BSN, RN. (2011). HiMSS11. Implementing ICD-10.

Retrieved October 7, 2011 from

http://www.himss.org