In this Issue:
NOTE: Click here to view an update on the HIPAA information, published December 9, 2011.
Effective January 1, 2012, the U.S. Department of Health and Human Services (HHS) has mandated the adoption of new HIPAA standards. The new HIPAA standards are known as Version 5010 and apply to covered entities (including dental practices) when administrative and financial data are exchanged between healthcare providers, health plans, and covered entities for patient care services.
All covered entities, including dental practices, will be required to use the new 5010 standards in place of the existing Version 4010A1 standards. The new 5010 standards have been developed to support the National Provider Identifier (NPI)* regulation and provide consistency across all transactions.
In addition, the new standards serve as the foundation for supporting future ICD-10 code sets. The International Statistical Classification of Diseases and Related Health Problems, 10th revision (known as "ICD-10") is a medical classification list for the coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. This code set is maintained by the World Health Organization.
Beginning January 1, 2012, if your office or practice management software vendor has not implemented and become prepared to use Version 5010 standards, your office runs the risk of adding significant cost, complexity and payment delays to your business processes. For this reason, you should work closely with your system vendor to ensure proper delivery of 5010 transactions. Even though software vendors are not included in the list of covered entities, they will need to upgrade their products to support HIPAA 5010 for their customers.
The risks to you of delivering 4010A1 claims after January 1, 2012, may include:
· Slower reimbursement speed
· No reimbursement
· Diversion of staff to less valuable activities for claims rework and follow up.
Providers submitting claims using the 4010 standards after January 1, 2012, will be required to manually intervene and review/augment every claim sent to payers in order to ensure claims meet the new 5010 criteria and payer requirements. For example, data required in the 5010 format might be missing from existing 4010 submissions and, without manual intervention, the claims submitted in 4010 without that data would be stopped by edits at the payer.
Transactions specified in the HIPAA 5010 standards that will be used in orthodontic offices are:
- Transaction #s 270/271: Health Care Eligibility Benefit Inquiry and Response
- Transaction #s 276/277: Health Care Claim Status Request and Response
- Transaction # 278: Health Care Service-Request for Review and Response; Health Care Services Notification and Acknowledgement
- Transaction # 835: Health Care Claim Payment/Advice
- Transaction # 837: Health Care Claim (Professional , Institutional, and Dental), including coordination of benefits (COB) and subrogation claims.
If your office files claims electronically and you have not already contacted your practice management software vendor, plan to do so in the very near future to ensure that your claims system is ready to support the new HIPAA 5010 standard on or before January 1, 2012.
* The Centers for Medicare and Medicaid Services (CMS) issues the National Provider Identifier to U.S. health care providers. A unique 10-digit identification number, the NPI is the required identifier for Medicare services. It is also used by other payers, including commercial healthcare insurers.
With a pledge of $38,627 from the Friends of Dr. J. Daniel Subtelny and Eastman Orthodontic Alumni, the AAO Foundation has reached its goal of $1.5 million for the AAOF Craniofacial Growth Legacy Collections Project. Dr. Robert J. Bray, AAO past president and current AAOF National Planned Giving Chair, expressed gratitude on behalf of the foundation to the Eastman alumni and to all supporters of the collections project.
Learn More about the Craniofacial Growth Legacy Collections Project
Make a Pledge
In the December AJO-DO Case of the Month, the author must decide how to treat a 15-year old female who has difficulty chewing because of an end-to-end incisor relationship, bilateral posterior open-bites, a class III malocclusion and five congenitally missing premolars. Many orthodontists would probably choose jaw surgery to correct these problems, but this severe malocclusion was treated with routine non-surgical orthodontics. One-year post-treatment stability of the posterior open-bite correction is documented.
View the Case of the Month Video
View the Article
December 19, 2011 is the deadline to register for the 2012 American Board of Orthodontics Written Examination, which will be April 17-20 at Pearson VUE Testing Centers. A first step toward becoming Board-certified and a prerequisite for the ABO Clinical Examination, the written examination assesses examinees' knowledge of basic sciences and clinical concepts. Any educationally qualified, practicing orthodontist may take the written examination. Students/residents may take the written examination if they have completed 18 months of orthodontic residency training at the time of the examination.
Learn More at the ABO Web Site
Register for the Exam