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5010: Started on January 1

It may seem unbelievable, but after many months of reading about it and preparing for it – 5010 is finally here. This past Monday, members of billing staffs around the nation needed to ensure that payers received claims using Version 5010 of the electronic transaction standards. Even though most practices have tested the new format and worked with vendors to ensure everything is in order, Monday marked the official date 5010 will be in full effect and the hours of preparation will pay off.

It cannot be denied that the long-term benefits of Version 5010 will help the entire industry become more standardized and will negate many variables in claims submission. After all, the main purpose of 5010 is to standardize the data content in all claims for all payers in healthcare. Over the next few months, as payers and practices begin to leverage the new system, all healthcare organizations are sure to realize 5010’s true benefits.

Since almost every practice across the nation has had to change how it submits claims to payers in some way, you will not be alone in experiencing the benefits and pitfalls of 5010. For those who have tested and worked with their vendors and clearinghouses, the transition should be relatively smooth. However, that does not mean that you should not anticipate a few glitches with the new electronic format – there are always glitches when implementing a new system.

Personally, I recommend that all practices carefully monitor claim rejections and denials over the next few weeks as a way to spot possible glitches with the transition to 5010. These two metrics can be the first signs of problems with your practice’s revenue cycle, and changes in these indicators can clue you in that something is amiss.

Should your practice see a drastic increase in the level of rejections or denials, reach out to your clearinghouse vendor and/or the payer directly to get to the bottom of the issue. Don’t wait and hope someone else will notice and fix the problem. Such delays can cost you significant funds.

Now that 5010 is truly underway, your practice can turn its attention to other changes ahead, such as preparing for ICD-10. Along with preparing for ICD-10, you may want to also consider using 5010’s anticipated benefits to work on improving your revenue by eliminating paper from your entire revenue cycle, or taking advantage of the ability to electronically submit claims for secondary insurance.