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Practice Management & Allied Staff News & Materials

Basic Steps to Prepare for Version 5010/ICD-10

March 28th, 2012

Implementation of ICD-10-CM is quickly approaching and offices must make sure they are compliant by the time the implementation date takes effect.  The HIPAA Version 5010 which replaced version 4010 on January 1, 2012, regulates the electronic transmission of specific healthcare transactions, including eligibility, claim status, referrals, claims and remittances and does accommodate ICD-10 coding. All HIPAA covered entities are required to comply. CMS has created a fact sheet which provides guidance to assist providers with claim submission difficulties while using version 5010. 

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 updates and ICD-10 codes, and when they expect to have it ready to install. Check your contract to see if upgrades are included as part of your agreement.
  • Discuss implementation plans with all your clearinghouses, billing services, and payers to ensure a smooth transition. Contact your payers, clearinghouse, billing service with whom you conduct business, ask about their plans for ICD-10 compliance, and when they will be ready to test their systems for the transition.
  • 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 Coding and Billing Workshops page of the AAOMS web site for information on educational offerings, such as the ICD-10-CM coding workshops, offered both in-person and online.
  • 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.