This past Monday, the Department of Health and Human Services (HHS) proposed that the ICD-10 implementation deadline be extended one full year to October 1, 2014, as opposed to the original October 1, 2013 deadline.

Multiple provider groups had expressed concerns to HHS about meeting the original compliance deadline for ICD-10. The extra year would give these providers and other covered entities more time to test and prepare their systems to help ensure a smoother transition.

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I’m a firm believer in learning from every opportunity that presents itself. The 5010 transition is one such golden opportunity, especially for payers.

In looking at how payers have responded to the HIPAA 5010 implementation, I’d say performance has been mixed. On one hand, many larger payers have been on top of the numerous technical aspects of 5010 and have been quite persistent in reaching out to clearinghouses and practices. They have done a good job getting ready, technically speaking, well in advance of the different conversion dates.

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Last week, the Centers for Medicare & Medicaid Services (CMS) announced they would once again delay enforcement of HIPAA 5010 standards – this time until June 30, 2012. The decision came after an assessment of industry experiences with the 5010 transition, including a letter sent by the MGMA-ACMPE^® to CMS requesting the enforcement deadline be extended because many of their association members were not ready. Among the reasons for their request was the fact that many practice administrators are still reporting significant delays in claim payments.

While not everyone has made the transition, CMS announced that many organizations – health plans, clearinghouses, providers and other technology vendors – have made significant progress towards transitioning to the new required HIPAA EDI standard. They anticipate that 98% of claims submitted by June 30^th will be 5010 compliant.

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The arrival of the 5010 electronic claims transaction standard has created quite a few questions in regard to the proper use of National Drug Codes (NDCs). Here are the answers to some frequently asked questions.

Question: I’ve heard conflicting requirements regarding NDC reporting—some only want NDCs on “not otherwise specified” codes (e.g., J3490). However, I’ve also heard that NDCs are necessary on every drug. Could you clarify?

Answer: NDCs are not required for every drug. The 5010 specification says NDCs are used: 1) when the government mandates it (e.g., for rebate programs) or 2) when you choose to report them to enhance claim reporting/adjudication. Many times a HCPCS code adequately describes the drug in terms of description, quantity and measurement type. However, for certain non-specific J codes like J3490, including either an NDC or a description likely would result in better claim processing.

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Thank you to everyone who attended our latest webinar on February 15, 5010: The Good, the Bad, and the Ugly. Ken Bradley, Vice President of Strategic Planning at Navicure, led the one-hour event, which focused on how the new HIPAA 5010 electronic standard. During the webinar, he offered advice about:

• How to leverage 5010 to improve business processes.
• The most common 5010 errors and how to avoid them.

To learn more about how to leverage 5010 effectively so your revenue cycle remains healthy, click here to download this webinar.

This program meets AAPC guidelines for 1.0 Core A or 1.0 CPCO specialty CEUs. On Demand product requires successful completion of a Post-Test for continuing education units. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.

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.

On January 1, 2012 HIPAA 5010 became the new required standard for electronic transactions. Are you wondering how to leverage the new 5010 standard effectively while ensuring your revenue cycle remains healthy?

Join us on Wednesday, February 15^th at 1:00 pm EST, for a complimentary webinar, 5010: The Good, the Bad, and the Ugly. Register Now.

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The month of January presents opportunities to not only consider the year ahead, but also look back at the year just passed. With this in mind, we wanted to take a look at our most popular blogs from 2011. As you’ll see, most of them merit revisiting as your practice plans for the future.

• HIPAA 5010 – Understanding Two Important New Requirements. This blog focuses on two changes medical practices must make to their claims submission process to be 5010 compliant: using a physical address as the provider billing address and incorporating nine-digit ZIP codes into billing provider and service facility addresses. While many practices have made these changes, we’re finding that some still need to do so. It’s important to note that technology vendors cannot make these changes for practices; practices must make them on their own.

• How Paper Claims Will Be Impacted by 5010. This blog clears up some confusion that still exists today about how 5010 affects paper-based claims. While most providers filing claims with Medicare and other payers need to be compliant with 5010, those providers or payers who meet certain exceptions to the HIPAA requirements and still file on paper aren’t subject to 5010 requirements. If you’re among those providers, you can continue filing paper claims as always—at least for now.

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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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