Ensure a Smooth Transition to 5010 January 13, 2012 HIPAA, Medicare, Payment, Technology 5010, Health Insurance Portability and Accountability A, ICD-10, Version 5010 0 Health care organizations that submit transactions electronically are required to upgrade from Version 4010/4010A to Version 5010 transaction standards. This mandate applies to anyone covered by the Health Insurance Portability and Accountability Act (HIPAA) and carries a January 1, 2012 deadline. To be compliant, organizations must use version 5010 to send and receive claims and all other HIPAA adopted electronic transactions starting January 1, 2012. CMS Office of E-Health Standards and Services (OESS) has announced that it would exercise its enforcement discretion with respect to any HIPAA covered entity that a complaint is filed against for violation of compliance with Version 5010, and the National Council for Prescription Drug Programs (NCPDP) D.0 and 3.0 standards. The enforcement discretion period is from January 1 to march 31, 2012. Steps to Ensure a Smooth Transition to 5010 Have a transition plan in place. This plan should document stapes that will be followed and the dates that milestones will be achieved to comply with 5010 requirements. Make your plan available to payers and other business partners so that testing can be scheduled. Communicate with vendors regularly. Providers should identify areas within their practice that depend on vendor support and communicate with their vendors accordingly to ensure their systems will be up-to-date. Hold vendors accountable by discussing business requirements to ensure products are 5010 compliant. Ask vendors about new 5010 features and request trainings to ensure internal staff is comfortable using the updated system. Lastly, talk to vendors about any contract upgrades or costs involved with implementing the new software. Reach out to a clearinghouse for assistance. A clearinghouse ensures that claims smoothly transition between practices and payers. When providers submit noncompliant claims, the clearinghouse translates the claims into a compliant format and sends the compliant transaction to payers. The clearinghouse serves as a translator from the 4010/4010A to 5010 format. Even if you normally submit your claims to your business partners directly, a clearinghouse can bridge the gap if you are behind in 5010 implementation, and maintain the submission and processing of your claims while you complete your transition. Establish a line of credit. Providers should work with their financial team to establish or increase a line of credit to cover potential cash flow disruptions. A line of credit will help a provider’s practice prepare for potential delays and denials in payer claims reimbursements due to noncompliant 5010 transactions being submitted. Take advantage of the free software available to Medicare Fee-for-Service (FFS) providers via Medicare Administrative Contractors (MACs). If you have not already done so, SFMS encourage its members to begin testing for 5010 to avoid claim submissions in 2012. Non-compliance with 5010 may also lead to difficulties meeting the October 1, 2013 ICD-10 transition deadline. Please visit www.cms.gov/ICD10 for more information and resources about 5010 and ICD-10. Comments are closed.
