ICD-10 and 5010:Medical billing future, are you prepared?
Posted by Patrick Ales on Wed, Apr 27, 2011 @ 12:55 PM
If you have been pre-occupied with the strained economy and the effects of that on your revenue cycle/medical billing, you may have forgotten about the ICD-10 and 5010 transitions that are begining to take place. These two transitions will require system and business changes throughout the health care industry. ICD-10 will affect coding for everyone covered by the Health Insurance Portability and Accountability Act (HIPAA), not just those who submit Medicare claims.
About the Version 5010 Transition on January 1, 2012
On January 1, 2012, standards for electronic health care transactions change from Version 4010/4010A1 to Version 5010. These electronic health care transactions include functions like claims, eligibility inquiries, and remittance advices. Unlike the current Version 4010/4010A1, Version 5010 accommodates the ICD-10 codes, and must be in place first before the changeover to ICD-10. The Version 5010 change occurs well before the ICD-10 implementation date to allow adequate Version 5010 testing and implementation time.
If providers do not conduct electronic health transactions using Version 5010 as of January 1, 2012, delays in claim reimbursement may result. If health plans cannot accept Version 5010 transactions from providers, they may experience a large increase in provider customer service inquiries affecting their operations.
Preparing for ICD-10 and Version 5010 – including potential updated software installation, staff training, changes to business operations and work flows, internal and external testing, reprinting of manuals and other materials, and more – will take time.
So ask yourself a question. Am I where I need to be at this stage of the game? The Centers for Medicare & Medicaid Services states per thier time line this is where you should have been as of January 2011.
| Date |
Compliance Step |
| 1-Jan-10 |
Payers and providers should begin internal testing of Version 5010 standards for electronic claims
|
| 31-Dec-10 |
Internal testing of Version 5010 must be complete to achieve Level I Version 5010 compliance |
| 1-Jan-11 |
Payers and providers should begin external testing of Version 5010 for electronic claims
|
| CMS begins accepting Version 5010 claims |
| Version 4010 claims continue to be accepted |
If you find yourself concerned by your answer to that question, feel free to contact us to help you get where you need to be. Sometimes outside consulting is just what you need to bring you up to speed. Other options would be to outsource your billing altogether with a company that is "ahead of the curve" such as we are.
Subscribe today as I will continue this topic with more information on ICD-10 next.
