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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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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The HIPAA 5010 transition deadline is January 1, 2012. Is your practice prepared? If not, your bottom line will suffer.

Time is running out, but if you take the proper steps now, you can be ready. Since 5010 enables ICD-10, come January 1, the industry will have completed its first step towards ICD-10 compliance. However, ICD-10 will have a much bigger impact than 5010 and will require providers to re-think all processes. Practices must be preparing for ICD-10 now.

Join us on Tuesday, December 6 at 1:00 pm EST, for a free webinar: 5010 and ICD-10 – What You Must Know Now. Register Now.

During this hour, you’ll hear industry expert, Ken Bradley, Vice President of Strategic Planning at Navicure, discuss:

• Where the industry is and where your practice should be with regards to 5010 and ICD-10
• What to do if you have not begun preparing for 5010
• How to fix the biggest problems practices are having with the 5010 requirements
• What steps you can take for ICD-10 revenue management success

Make sure that your practice is prepared for these transitions.

 Participants can earn 1.0 Continuing Education Unit (CEU) from the American Academy of Professional Coders (AAPC) by attending.

Register Now.

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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Last week, I had the pleasure of attending the Medical Group Management Association’s annual meeting in Las Vegas. During the conference, I was excited to speak with other practice managers, physicians and technology vendors about the constant changes in the medical field – including how people handle ongoing issues such as denials management and revenue cycle management.

In addition to these insightful conversations, I had the honor of leading an educational session about preparing for the pending 5010 and ICD-10 transitions. During the hour, I provided tips about how every practice can prepare for the implementation of both 5010 and ICD-10, especially focusing on how practices can ensure that they have mitigated the possibility of revenue cycle disruptions during the transitions. During the session, there were many great questions and I was happy to see people starting to think about the transition to ICD-10. In addition, Healthcare Finance News wrote a quick synopsis of the session, which you can read here.

I look forward to hearing how people take these recommendations and apply them to their own practice. As your organization works towards both implementation deadlines, let everyone know how it is going by adding a comment in the boxes below.

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.