Practice Management & Allied Staff News & Materials
Basic Steps to Prepare for Version 5010/ICD-10
November 29th, 2011
Begin preparing now for the ICD-10 transition to make sure you are ready by the October 13, 2013, compliance deadline. CMS' ICD-10 Web site has many resources to assist providers with preparing for the transition to ICD-10, and even before that, the transition to the 5010. Beginning on January 1, 2012, HIPAA version 5010 will be replacing HIPAA 4010A1. The new 5010 is what covered entities must use when conducting electronic transactions including; claims, payment to providers, eligibility requests, referrals, enrollment/disenrollment in health plans, and Coordination of Benefits. While the HIPAA 5010 implementation date is January 1st, 2012, strict enforcement will be taken beginning March 31, 2012. If a provider is not compliant with the HIPAA 5010 transaction standard he or she will have to provide evidence that they are making a good faith effort to comply with the new HIPAA standards during the 90-day period if asked by the Centers for Medicare & Medicaid Services' Office of E-Health Standards and Services (OESS).
The following quick checklist will assist you with preliminary planning steps.
- Identify your current systems and work processes that use ICD-9 codes. This could include clinical documentation, encounter forms/super-bills, practice management system, electronic health record system, contracts, and public health and quality reporting protocols. It is likely that wherever ICD-9 codes now appear, ICD-10 codes will take their place.
- Talk with your practice management system vendor about accommodations for both Version 5010 and ICD-10 codes. Contact your vendor and ask what updates they are planning to your practice management system for both Version 5010 and ICD-10, and when they expect to have it ready to install. Check your contract to see if upgrades are included as part of your agreement. If you are in the process of making a practice management or related system purchase, ask if it is Version 5010 and ICD-10 ready.
- Discuss implementation plans with all your clearinghouses, billing services, and payers to ensure a smooth transition. Be proactive, don't wait. Contact your payers, clearinghouse, billing service with whom you conduct business, ask about their plans for the Version 5010 and ICD-10 compliance, and when they will be ready to test their systems for both transitions.
- Talk with your payers about how ICD-10 implementation might affect your contracts. Because ICD-10 codes are much more specific than ICD-9 codes, payers may modify terms of contracts, payment schedules, or reimbursement.
- Identify potential changes to work flow and business processes. Consider changes to existing processes including clinical documentation, encounter forms, and quality and public health reporting.
- Assess staff training needs. Identify the staff in your office that code, or have a need to know the new codes. Watch the ICD-10-CM and Coding and Billing Workshops pages of the AAOMS web site for information on educational offerings coming soon.
- Budget for time and costs related to ICD-10 implementation, including expenses for system changes, resource materials, and training. Assess the costs of any necessary software updates, reprinting of super-bills, training and related expenses.
- Conduct test transactions using Version 5010/ICD-10 codes with your payers and clearinghouses. Testing is critical. Allow yourself enough time to first test that your Version 5010 transactions, and subsequently, claims containing ICD-10 codes are being successfully transmitted and received by your payers, clearinghouses, etc. Check to see when they will begin testing, and the test days they have scheduled.