A few weeks ago, I spoke with the editor of ICD-10 Watch about how the transition to the new HIPAA 5010 electronic transaction standard went. Since the 5010 compliance deadline earlier this month, healthcare payers have had to learn to manage and respond to unexpected problems with medical claim rejections and denials. We discussed some of the specific problems that may be causing issues for practices, as well as the importance of tracking claims to ensure the reimbursement that practices receive is what they anticipated.

After our discussion, the editor wrote an article that summarized our discussion and the most common 5010-related problems practices are experiencing, along with the correction to these problems. You can read the full article here to learn more.

It has been several weeks since HIPAA 5010 became the required electronic transaction standard, and by now many practices are beginning to see how the many changes are impacting claim rejections. For the past couple of weeks, I have been monitoring trends in claim rejections—specifically looking at ones that are directly related to 5010. As can be expected, there has been an uptick in a number of rejections. Within all of these rejections, five specific ones caught my eye because each one could easily be corrected so practices can avoid such rejections in the future. Here is a quick look at these five rejections and how to prevent them:

1. No Medicare Secondary Payer (MSP) reason code on a primary claim. In Version 4010, claims only required MSP on secondary claims submitted directly to Medicare. Now, however, healthcare providers must submit an MSP indicator on both the primary and secondary claim when Medicare is reported as the secondary payer. If this information is not included, the claim will be rejected.

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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.

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As an industry, the transition to HIPAA 5010 has been a learning opportunity – especially showing the benefits of planning and questioning a vendor’s capabilities early on. These lessons can be taken and applied to the next big transition – ICD-10, which will be the required coding set starting on October 1, 2013. Many people in the industry believe that there is plenty of time before the transition, and that they can start the transition process at a later time. However, now is the time for practices to start preparing for the coding change. So when I was recently given the opportunity to speak with a writer from For the Record about how the transition to ICD-10 would impact the industry and how practices should prepare, I was happy to share my thoughts.

At the start of this conversation, we focused on how this transition would impact everyone in the healthcare industry. It was the coders, though, that quickly became the focal point of our discussion. Specifically, we talked about the types of questions coders should be asking when preparing an ICD-10 transition plan. These questions include:

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Medicare has announced that it plans to delay enforcement of the 5010 electronic transaction standards—but not the compliance date. (For those of you who lived through the initial HIPAA electronic transactions and code sets implementation in 2003, the announcement may feel like déjà vu.)

On November 17, the Centers for Medicare & Medicaid Services (CMS) Office of E-Health Standards and Services (OESS) issued a press release stating that it will not enforce compliance with the new 5010 transaction standards until March 31, 2012. However, the actual compliance date remains January 1, 2012.

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We’ve all seen—or asked—a question like this:

“I work for a provider who doesn’t submit claims electronically, and doesn’t plan to start because he’s retiring in a few years. How does 5010 affect providers who still submit claims on paper?”

Search for the answer and you’ll find a lot of confusion. Many, for example, are under the impression that after Jan. 1, 2012, all payers are obligated to ban paper claims and allow only electronic transactions. That’s not quite true.

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By this point, everyone in the healthcare industry is aware that the deadline to transfer to HIPAA 5010 is January 1, 2012—which is only two away at this point!

Even though many practices and technology vendors have been preparing for this change for a year or two, many organizations still have questions about how 5010 is going to impact them. And they are also wondering what they should be doing right now to be sure their practice is completely prepared for HIPAA 5010.

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The process of preparing for and converting to ICD-10 has many moving parts. As practices, health plans, and other vendors work toward the October 1, 2013 deadline, I have been hearing lots of questions about how to successfully manage the conversion. Today, I will answer a few of the more commonly asked questions pertaining to the conversion.

At this point, what stage should our payers be in regarding ICD-10 implementation? Should they be ahead of us?

Since payers and vendors will lay the technology groundwork for what practices must do to successfully transition to ICD-10, they should be well into their ICD-10 work plan and ahead of where practices are today. Most large health plans are in the midst of readying themselves for the new code set and may be starting small tests. It is a good idea to reach out to your payers to understand their progress to date, as well as how you can work with them to make the ICD-10 transition as smooth as possible.

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With the transition to HIPAA Version 5010 quickly approaching, practices must verify that their health information technology (HIT) vendors will be ready for the change. If not, practices risk significant disruptions to cash flow on the January 1, 2012 implementation date. The conversion will affect most major healthcare transactions and nearly all technology, practices and HIT vendors—all who need to make sure they are fully prepared. While every vendor must take specific steps to get ready, clearinghouses bear the rather unique burden of ensuring that claims will cross smoothly between payers and practices.

For practices, it is important to begin communicating now—especially with clearinghouses—to determine whether testing is necessary and, if so, what the 5010 testing schedules are. Past experience with conversions to the current 4010A1 standard and the National Provider Identifier (NPI) suggests the 5010 transition will be the smoothest and least risky if staggered by payer over the course of 2011. Practices can assess progress on the part of their clearinghouses by watching for a few preparation milestones.

Click here to read the entire article I wrote for Tennessee Medicine and learn which milestones you should be looking for from your clearinghouse.

A few weeks ago I had a great conversation with the editor of ICD-10 Watch about the pending transition to HIPAA 5010 and what it means to all practices in the nation. During this exchange, we discussed how National Testing Day went back in August and how my own company is preparing for the transition. After a short time, we turned our focus to what practices should be doing right now to get ready for 5010—including the different items that practices should be doing if they have a clearinghouse or if they file directly with payers.

The editor then proceeded to write a great column about this conversation, where he eloquently shared my tips for all of those that have not yet started to prepare. Now, I truly believe that all practices can prepare for the transition and still have time, but if you are beginning to stress about the transition, you can read the entire article here.