As we draw ever closer to the June 30 extended enforcement deadline for upgrading to version 5010 standards, the industry winds down its transition efforts for the new electronic health transactions standard. So our collective focus is now free to focus on… what else? More compliance mandates. Yes, just when you thought you were done, there’s more.

Between now and 2016, the industry will undergo significant transformation as it works toward achieving new standards for transactions and electronic medical records.

If 5010 seemed like a lot of work, just wait for ICD-10. We may get a bit of a reprieve on the Oct. 1, 2013 deadline, as the Department of Medicare and Medicaid Services is evaluating a proposed rule that would delay the deadline by one year.

That might buy you some time to manage adherence to multiple compliance phases for “meaningful use” – that elusive standard that will determine whether you will recoup some of your investment in electronic health records from the government, as outlined in the Health Information Technology for Economic and Clinical (HITCH) Act of 2009.

As a reminder, you have until 2014 to achieve meaningful use to be eligible for incentive payments.

Another compliance mandate that may be flying under your radar is the operating rules associated with administrative simplification regulations, per the Patient Protection and Affordable Care Act of 2010. New operating rules were added to this health care reform legislation to ensure uniformity in the implementation and use of the electronic HIPAA transactions.

These administrative simplifications will make it easier for you to take full advantage of these transactions. The rules for the eligibility transaction, for example, will require new service type codes and the return of additional benefit information, such as coverage and remaining deductible, to your practice. The legislation also includes revamping the current health plan identifiers, rules for electronic funds transfer (EFT) and implementation of the claims attachment (275) format.

Keep in mind the following important compliance dates and the transactions that will be affected:

  • January 1, 2013
  • Eligibility and Benefits (270 / 271)
  • Claim Status (276 / 277)
  • January 1, 2014
  • Electronic Funds Transfer (EFT) and Remittance Advice (835)
  • October 1, 2014
  • Unique Health Plan Identifier