If you’ve been involved in medical billing for any length of time, you’re already familiar with HIPAA. HIPAA 5010 refers to a new version of HIPAA that includes structural and functional improvements. This article summarizes some of the major changes in HIPAA to help you understand what has stayed the same and what is new.

Changes in Data Content

There are new changes in data content that could require an overhaul of existing software.  The goal is to collect extracted data and transmit it in a way that has increased security and clear rules. This also changes the game with regard to the data content that will need to be submitted along with health claims.

The 5010 version of HIPAA can determine the differences between principal diagnosis, external cause of injury, admission diagnosis, international precipitating factors, external precipitating factors, internal cause of injury and reason’s for a patient’s visit. This will ultimately improve analysis of data and result in a better understanding of what visits and treatments are being recorded and performed. This will also lead to a better understanding of mortality data.

  • Data content improvements may require tweaks to your existing software and systems, but will ultimately improve data analysis and increase security.

Compulsory Usage of Electronic Claims

The requirement for electronic claims should help your workflow and your profits. Except in rare cases, electronic claims are required so that healthcare providers are able to receive their payments and reimbursements as expected. Since early 2012, healthcare providers have been required to submit their claims electronically. This might require some additional training on your part for those staff responsible for this task, but it should also cut down on paperwork completed in-office and speed up the process between submitting claims and being paid.

Since most businesses are transferring their processes to an online system to make things more standardized and speed up turnaround times, it’s not surprising that this trend would eventually reach the healthcare industry.

  • Electronic claims submissions will make life easier over time for practices, but may require an adjustment period as staff become familiar with new upgrades.

Bottom Line for Vendors

Software vendors will be on the front line for ensuring that HIPAA-covered entities are in compliance. Even though vendors are not listed as entities that are covered, they still interact with these businesses on a regular basis and are connected in some way to the data. For this reason, vendors are still responsible for upgrading products to be in compliance for HIPAA 5010. It might be worth a conversation at the least or even a training seminar held by the clinic to review the IT infrastructure in-house. Since these software compliance issues may impact a broader portion of the practice, it could be helpful to examine the total infrastructure for standards.

Vendors can be of assistance when it comes to new HIPAA 5010 compliance by having the structure to support HIPAA compliance and assisting offices with the transition.


Clean Claims On First Submission




HIPAA Compliance


Increase in Collections

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